Randomised trial of ‘intelligent’ autotitrating ventilation versus standard pressure support non-invasive ventilation: Impact on adherence and physiological outcomes¹

JULIA L. KELLY,* JAY JAYE,* RACHEL E. PICKERSGILL, MICHELLE CHATWIN, MARY J. MORRELL AND ANITA K. SIMONDS

Optimal ventilator settings are required for effective non-invasive ventilation (NIV). Intelligent volume-assured pressure support (iVAPS) provides automatic adjustments determined by the patient’s requirements.

Patient intolerance to the level of pressure support (PS) required for therapeutic benefit is common.

The study tested the hypothesis that iVAPS was non-inferior to standard PS ventilation when the settings are determined by an experienced professional.

Twenty-three patients with newly diagnosed nocturnal hypoventilation due to chronic obstructive or restrictive lung disease were randomised to iVAPS or standard PS for one month. They then received the crossover treatment for one month.

Eighteen patients completed both treatment periods.

Mean night-time use for the iVAPS mode was greater than for the standard PS mode and patients showed a preference for iVAPS over standard PS.

Overnight oxygenation and partial pressure of transcutaneous carbon dioxide (PtcCO2) did not differ between the two modes.

Total sleep time, sleep latency, arousals, sleep efficiency and sleep architecture were comparable.

There were no significant changes in spirometry or respiratory muscle strength.

The authors commented:

"Lower pressures in the iVAPS mode during this study may have contributed to patients’ preference for this mode and to increased adherence."