Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial.

Volume-targeted noninvasive ventilation (VT-NIV), a hybrid mode that delivers a preset target tidal volume (VT) through the automated adjustment of pressure support, could guarantee a relatively constant target VT over pressure-limited noninvasive ventilation (PL-NIV) with fixed-level pressure support. Whether VT-NIV is more effective in improving ventilatory status in subjects with acute hypercapnic respiratory failure (AHRF) remains unclear. Our aim was to verify whether, in comparison with PL-NIV, VT-NIV would be more effective in correcting hypercapnia, hence reducing the need for intubation and improving survival in subjects with AHRF. We performed a prospective randomized controlled trial in the general respiratory wards of 8 university-affiliated hospitals in China over a 12-month period. Subjects with AHRF, defined as arterial pH <7.35 and ≥7.25 and PaCO2 >45 mm Hg, were randomly assigned to undergo PL-NIV or VT-NIV. The primary end point was the decrement of PaCO2 from baseline to 6 h after randomization. Secondary end points included the decrement of PaCO2 from baseline to 2 h after randomization as well as outcomes of subjects (eg, need for intubation, in-hospital mortality). A total of 58 subjects were assigned to PL-NIV (29 subjects) or VT-NIV (29 subjects) and included in the analyses. The decrement of PaCO2 from baseline to 6 h after randomization was not statistically different between the PL-NIV group and the VT-NIV group (9.3 ± 12.6 mm Hg vs 11.7 ± 12.9 mm Hg, P = .48). There were no differences between the PL-NIV group and the VT-NIV group in the decrement of PaCO2 from baseline to 2 h after randomization (6.4 ± 12.7 mm Hg vs 5.0 ± 15.8 mm Hg, P = .71) as well as in the need for intubation (17.2% vs 10.3%, P = .70), and in-hospital mortality (10.3% vs 6.9%, P > .99). Regardless of whether a VT- or PL-NIV strategy is employed, it is possible to provide similar support to subjects with AHRF. (ClinicalTrials.gov registration NCT02538263.).

Cao Z ，Luo Z ，Hou A ，Nie Q ，Xie B ，An X ，Wan Z ，Ye X ，Xu Y ，Chen X ，Zhang H ，Xu Z ，Wang J ，An F ，Li P ，Yu C ，Liang Y ，Zhang Y ，Ma Y ... -  《-》

Delayed but successful response to noninvasive ventilation in COPD patients with acute hypercapnic respiratory failure.

Lemyze M ，Bury Q ，Guiot A ，Jonard M ，Mohammad U ，Van Grunderbeeck N ，Gasan G ，Thevenin D ，Mallat J ... -  《International Journal of Chronic Obstructive Pulmonary Disease》

Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients.

Gursel G ，Zerman A ，Basarik B ，Gonderen K ，Aydogdu M ，Memmedova S ... -  《-》

Home noninvasive positive pressure ventilation with built-in software in stable hypercapnic COPD: a short-term prospective, multicenter, randomized, controlled trial.

Zhou L ，Li X ，Guan L ，Chen J ，Guo B ，Wu W ，Huo Y ，Zhou Z ，Liang Z ，Zhou Y ，Tan J ，Chen X ，Song Y ，Chen R ... -  《International Journal of Chronic Obstructive Pulmonary Disease》

Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit.

Contou D ，Fragnoli C ，Córdoba-Izquierdo A ，Boissier F ，Brun-Buisson C ，Thille AW ... -  《-》