Novel modes of non-invasive ventilation in chronic respiratory failure: a narrative review

Journal of Thoracic Disease

article

Neeraj Mukesh Shah¹  Rebecca F. D’Cruz¹  Patrick B. Murphy¹ 

[1] St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust;Lane Fox Clinical Respiratory Physiology Centre, Guy’s and St Thomas’ NHS Foundation Trust;Centre for Human and Applied Physiological Sciences (CHAPS), King’s College London

关键词: Non-invasive ventilation (NIV);    chronic respiratory failure;    domiciliary ventilation;    auto-titrating;    pressure-targeted;    volume-targeted;   

DOI  :  10.21037/jtd-cus-2020-013

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Home non-invasive ventilation (NIV) is central in the management of chronic hypercapnic respiratory failure and is associated with improvements in clinically relevant outcomes. Home NIV typically involves delivery of fixed positive inspiratory and expiratory airway pressures. These pressures do not reflect physiological changes to respiratory mechanics and airway calibre during sleep, which may impact on physiological efficacy, subsequent clinical outcomes, and therapy adherence. Novel ventilator modes have been designed in an attempt to address these issues. Volume-assured pressure support modes aim to automatically adjust inspiratory pressure to achieve a pre-set target tidal volume. The addition of auto-titrating expiratory pressure to maintain upper airway calibre is designed for patients at risk of upper airway collapse, such as obese patients and those with obstructive sleep apnoea complicating their hypercapnic failure. Heterogeneity in setup protocols, patient selection and trial design limit firm conclusions to be drawn on the clinical efficacy of these modes. However, there are data to suggest that compared to fixed-pressure NIV, volume-assured modes may improve nocturnal carbon dioxide, sleep quality and ventilator adherence in select patients. The use of the forced oscillation technique to identify expiratory flow limitation and adjust expiratory pressure to eliminate it is the most recent addition to these advanced modes and is yet to be assessed in formal clinical trials.

【 授权许可】

Unknown