Volume-targeted Versus Pressure-limited Noninvasive Ventilation in Patients With Acute Hypercapnic Respiratory Failure

Capital Medical University

Status: Completed

Conditions: Acute Hypercapnic Respiratory Failure

Treatments: Device: Volume-targeted noninvasive ventilation

Study type: Interventional

Funder types: Other

Identifiers

NCT02538263

BeijingCYH-ICU-001

Details and patient eligibility

About

Volume-targeted noninvasive ventilation (VT-NIV), a hybrid mode that targets a preseted tidal volume (VT) by automated adjustment of pressure support, could guarantee the delivered VT over pressure-limited noninvasive ventilation (PL-NIV) with fixed level pressure support. Whether VT-NIV is more effective in improving gas exchange in patients with acute hypercapnic respiratory failure (AHRF) as compared with PL-NIV remains unclear. Our aim was to verify whether in comparison with PL-NIV, use of VT-NIV was more effective in correcting hypercapnia, hence reducing the need for intubation and improving survival in patients with AHRF.

Enrollment: 58 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• acute hypercapnic respiratory failure (AHRF)
• arterial pH <7.35 and ≥7.25
• PaCO2 >45 mmHg

Exclusion criteria

• age <18 years
• excessive amount of respiratory secretions or weak cough
• upper airway obstruction
• recent oral, facial or cranial trauma or surgery
• recent gastric or esophageal surgery
• severe metabolic acidosis; severe abdominal distension
• cardiac or respiratory arrest
• PaO2/FiO2 <150 mmHg
• pneumothorax
• severe ventricular arrhythmia or myocardial ischemia
• severe hemodynamic instability despite fluid repletion and use of vasoactive agents
• active upper gastrointestinal bleeding
• lack of cooperation
• refusal to receive NIV

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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58 participants in 2 patient groups

Volume-targeted noninvasive ventilation

Experimental group

Description:

For Volume-targeted noninvasive ventilation, the target VT was set at 10 ml/kg of ideal body weight, with inspiratory positive airway pressure (IPAP) ranging from 10 cmH2O up to 25 cmH2O.

Treatment:

Device: Volume-targeted noninvasive ventilation

Pressure-limited noninvasive ventilation

No Intervention group

Description:

For Pressure-limited noninvasive ventilation, IPAP was initially set at 10 cmH2O, and was adjusted by increments of 1-2 cmH2O according to patients' tolerance (up to 25 cmH2O) to obtain a VT of 8-10 ml/kg of ideal body weight and a respiratory rate (RR) less than 25 breaths/min.