Respiratory muscle activity and patient-ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: Does high inspiratory pressure lead to respiratory muscle unloading?

Marieke L. Duiverman*, Anouk S Huberts, Leo A. van Eykern, Gerrie Bladder, Peter J. Wijkstra

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Abstract

    Introduction: High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient-ventilator asynchrony (PVA).

    Patients and methods: Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA.

    Results: Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017).

    Conclusion: High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.

    Original languageEnglish
    Pages (from-to)243-257
    Number of pages15
    JournalInternational Journal of Chronic Obstructive Pulmonary Disease
    Volume12
    DOIs
    Publication statusPublished - 11-Jan-2017

    Keywords

    • electromyography
    • high-intensity NIV
    • chronic obstructive pulmonary disease
    • ineffective efforts
    • OBSTRUCTIVE PULMONARY-DISEASE
    • RANDOMIZED CONTROLLED-TRIAL
    • MECHANICAL VENTILATION
    • SUPPORT VENTILATION
    • CROSSOVER TRIAL
    • HIGH-INTENSITY
    • REHABILITATION
    • DETERMINANTS
    • MULTICENTER
    • REDUCTION

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