Controlled cycles in spontaneous-timed noninvasive ventilation: Incidence and associated factors.

BACKGROUND: The most-used ventilation mode in home mechanical ventilation (HMV) is spontaneous-timed, designed to be essentially spontaneous with a programmed backup rate. RESEARCH QUESTION: We do not know the real frequency of activation of controlled cycles, nor its associated factors. STUDY DESIGN: and Methods: We conducted a single-center cohort study of patients with chronic hypoventilation who were started on HMV. We collected the clinical variables, the ventilator programming parameters and the ventilation efficacy data obtained from the built-in software. We analyzed the percentage of controlled cycles (PCC) and the potentially associated clinical variables. RESULTS: Overall, the PCC was very high (median 44%), with little change during the HMV adaptation period. Individuals with a higher PCC (captured patients) had a lower respiratory rate with ventilation, a higher level of ventilatory assistance, and were not associated with a specific clinical profile. INTERPRETATION: Controlled cycles are very common during spontaneous-timed ventilation and depend on the patient's ventilatory pattern and the level of ventilatory assistance.

Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: a randomized trial with cost assessment.

BACKGROUND: Home mechanical ventilation is usually initiated in hospital. However, cost-effectiveness of inpatient set up has never been compared to outpatient adaptation in a randomized design. A Prospective, multicenter, non-inferiority trial was conducted comparing the effectiveness of adaptation to noninvasive mechanical ventilation (NIMV) performed in the ambulatory or hospital setting in patients with chronic respiratory failure secondary to restrictive thoracic disease, obesity-hypoventilation syndrome or neuromuscular disease. METHODS: The study included 53 candidates for NIMV, randomized to ambulatory adaptation (AA) (n = 27) or hospital adaptation (HA) (n = 26). The patients' characteristics were recorded before establishing ventilation and at 1 and 6 months after. The main outcome variable was PaCO2 decrease at 6 months following initiation of NIMV. The direct costs of the two interventions were compared. RESULTS: Before starting NIMV, PaCO2 was 50.4 ± 6.8 mmHg in the AA group and 50.3 ± 5.7 mmHg in the HA group. At 6 months of NIMV use, a significant improvement in PaCO2 relative to baseline was found in both groups: mean (95% CI) PaCO2 decrease was 4.9 (2.3; 7.4) mmHg in AA and 3.3 (1.4; 5.1) mmHg in HA. The direct calculated cost was 1500 euros per patient in AA and 2692 euros per patient in HA. CONCLUSIONS: Adaptation to NIMV in the ambulatory setting is not inferior to hospital adaptation in terms of therapeutic equivalence in stable patients with chronic respiratory failure secondary to restrictive thoracic disease, obesity-hypoventilation syndrome or neuromuscular disease. Outpatient adaptation may represent a cost saving for the healthcare system. CLINICAL TRIAL: Identifier number NCT00698958 at www.clinicaltrials.gov.