Home Mechanical Ventilation for COPD: High-Intensity Versus Target Volume Noninvasive Ventilation

BACKGROUND: High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V-T NIV) provides additional benefits remains unclear. METHODS: Subjects with COPD successfully established on long-term HI-NIV were switched to target V-T NW. Optimal target V-T settings according to nocturnal transcutaneous P-CO2 measurements were achieved following a randomized crossover trial using 8 mL/kg ideal body weight and 110% of individual V-T during HI-MV, respectively. The following parameters were compared at the beginning of the trial while subjects were on HI-NW, and after 3 months on optimal target V-T NIV: sleep quality by polysomnography, overnight gas exchange, subjects' tolerance, overnight pneumotachygraphic measurements during NW, health-related quality of life (severe respiratory insufficiency questionnaire), exercise capacity (6-min walk test), and lung function. RESULTS: Ten of 14 subjects completed the study. There were no differences between HI-NIV and target V-T NIV in any of the above-mentioned parameters. Specifically, the mean overnight transcutaneous P-CO2, was equivalent under each form of ventilation (both 45 +/- 5 mm Hg, P = .75). CONCLUSIONS: Switching subjects from well-established HI-NIV to target V-T NIV shows no clinical benefits in chronic hypercapnic COPD. In particular, sleep quality, the control of nocturnal hypoventilation, daytime hypercapnia, overnight ventilation patterns, subjects' tolerance, health-related quality of life, lung function, and exercise capability were all similar in subjects who underwent HI-NIV and target V-T NW. Nevertheless, target V-T NW might offer some physiological advantages in breathing pattern and might be beneficial in some individual patients. (German Clinical Trials Register Iwww.drks.dej Registration DRKS00000450.)