Treatment of severe exacerbation of chronic obstructive pulmonary disease with mask-applied continuous positive airway pressure

Respirology13189-193RSPI

Subjective sleep quality during average volume assured pressure support (AVAPS) ventilation in patients with hypercapnic COPD. A Physiological Pilot Study.

Non-invasive Positive Pressure Ventilation (NPPV) is an advanced treatment (1) aimed to improve both physiological (2-4) and clinical outcomes (5-7), including sleep (8-10), during the long-term management of patients with Chronic Respiratory Failure (CRF) due to severe hypercapnic Chronic Obstructive Pulmonary Disease (COPD). Several studies evaluating the nocturnal application of mask ventilation in stable COPD patients (11-13) have shown a limited effectiveness of pressure based modes of NPPV in this patient group. However, further studies have shown that compliance to ventilation may influence the long-term efficacy of this treatment as patients who are compliant with NPPV are able to maintain arterial blood gase (ABG) improvements over 6-months when compared with those who discontinued this therapy (14).A new NPPV modality, called Average Volume Assured Pressure Support (AVAPS), combines both the pressure and volume characteristics of ventilation and, accordingly, delivers a range of inspiratory pressures to guarantee a pre-fixed inspiratory tidal volume. This hybrid mode of ventilation has been studied in intubated patients with acute respiratory failure (15) and in patients with chronic hypoventilation linked to obesity (16,17) and other conditions (16). Under these circumstances AVAPS is able to induce high pulmonary volumes and reduce muscle workload, thus providing physiological benefits and comfort similar to those achieved by pressure support (PS) modes. However, positive effects on sleep quality have not yet been confirmed.This pilot evaluated short-term compliance, night-time efficacy and physiological responses to Average Volume Assured Pressure Support (AVAPS) ventilation in patients with stable hypercapnic COPD

Perturbação respiratória durante o sono em doença pulmonar obstrutiva crônica Respiratory disturbance during sleep in chronic obstructive pulmonary disease

A doença pulmonar obstrutiva crônica é uma condição freqüente e é hoje a quarta principal causa de mortes nos Estados Unidos. A prevalência de perturbação respiratória durante o sono, ou síndrome de superposição, como anteriormente denominada, ainda não foi determinada devido à publicação de relatos conflitantes. Esta condição deve continuar sendo investigada devido aos efeitos adversos causados por transtornos respiratórios relacionados ao sono em pacientes com doença pulmonar de base. Neste relato, discutiremos brevemente os mecanismos envolvidos na origem da perturbação respiratória durante o sono em doença pulmonar obstrutiva crônica e auxiliaremos o leitor a distinguir àqueles pacientes que se beneficiariam de uma avaliação do padrão do sono mais detalhada, com a discussão de tópicos de gerenciamento e opções de tratamento.<br>Chronic obstructive pulmonary disease is a prevalent condition and is currently the forth leading cause of mortality in the US. The prevalence of respiratory disturbance during sleep, or overlap syndrome as it was commonly known in the past, is still undetermined as conflicting reports have been published. Because of the adverse effects of sleep-related respiratory impairment in patients with underlying pulmonary disease, this condition deserves further investigation. In this report, we will briefly discuss the mechanisms involved in generating respiratory disturbance during sleep in Chronic Obstructive Pulmonary Disease and will guide the reader into distinguishing those patients who would benefit from a more detailed sleep evaluation, discussing management issues and treatment options