Effect of different modes of NIV in neuromuscular disease

Background: Noninvasiveventilation(NIV)isusedinpatientswithchronicneu-
romusculardisorders,butwhichmodeofventilationisassociatedwithanoptimal
patient-ventilatorinteractionispoorlyknown
Objectives: WecompareddifferentmodesofNIVi.e.pressuresupportwithvol-
ume guarantee(PSV-VG),pressuresupport(PSV)andassistedpressuresupport
(APCV)inneuromuscularpatientsonnocturnalpolygraphicvariables,including
patient-ventilatorsynchrony,andondiurnalbloodgases.
Methods: Twentyeightpatientswithneuromusculardiseasewereincluded.The
threeventilatorymodeswereappliedinthreeconsecutivenights.Duringeachnight
a cardio-respiratorypolygraphicmonitoringwasperformed.Thenextmornings
arterialbloodgasesweremeasured.Analysiswasextendedtorecurrenceofmajor
patternsofasynchrony
Results: No significantdifferencesinnocturnalanddiurnalbloodgaseswere
found.Prolongedinsufflationwasthemost frequentasynchronyandwasstrictly
correlatedwiththemagnitudeofleaksineachmodalityofNIV(PSV-VGr=0.53
p=0.005,PSVr=0.67p=0.0004,PSVplusPEEPr=0.61p=0.001,APCVr=0.62
p=0.0001,APCVplusPEEPr=0.55p=0.003).Thenumberofprolongedin-
spirationswasstatisticallyhigherinPSVmodethaninAPCVmode(p=0.028).
Ineffectiveefforts(IE)werefoundmainlyinthePSV-VTGmodeandwere
correlatedwithdurationofleaks(r=-0.49,p=0.027)andBMI(r=-0.39,p=0.03
Conclusion: Differentmodesofventilationmaybeassociatedwithadifferentin-
cidenceofpatient-ventilatorasynchronies,althoughsignificantdifferencesintheir
effectsondiurnalornocturnalrespiratoryfunctionmaynotbeacutelydetected