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

Beijing Chao Yang Hospital58 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Acute Hypercapnic Respiratory Failure

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

The decrease of arterial partial pressure of carbon dioxide (PaCO2) values from baseline to 6 hours after randomization

PaCO2 value at baseline minus PaCO2 value at 6 hours after randomization

Time frame: 6 hours after randomization