Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: a randomized crossover study(2016)

  • 2016.01.01 Friday
  • 09:00

Crescimanno G, Greco F, Arrisicato S, Morana N, Marrone O. Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study. Respirology. 2016 Oct;21(7):1307-13. doi: 10.1111/resp.12836. Epub 2016 Jun 20. PMID: 27323697.

 

Background and objective: No studies have evaluated the impact of different settings of non-invasive ventilation (NIV) in patients affected by amyotrophic lateral sclerosis (ALS). We explored consequences of positive end-expiratory pressure (PEEP) application on effectiveness of ventilation, sleep architecture and heart rate variability (HRV) in patients with ALS naïve to ventilatory treatment.

Methods: In two consecutive nights, 25 patients received in random order 0 or 4 cm H2 0 of PEEP during nocturnal NIV administration (Idea Ultra ResMed) with the same level of total positive inspiratory pressure. Polysomnographies were performed to evaluate sleep and NIV quality, as well as HRV. HRV was analyzed on 4-h periods and on 5-min segments of stable NREM sleep.

Results: We did not observe differences in gas exchanges during NIV with and without PEEP. Conversely, during PEEP application increases in leaks (41.4 ± 29.3% vs 31.0 ± 25.7%, P = 0.0007) and in autotriggerings (4.2 (IQR 1.3-10.0) vs 0.9 (IQR 0.0-3.0) events/h, P < 0.001, PEEP vs no PEEP, respectively) occurred. Besides, N3 sleep stage duration decreased (2.5% (IQR 0.0-18.0) vs 0.0% (IQR0.0-12.1), P = 0.001) and arousal/awakening index increased (16.9 ± 7.4 vs 13.4 ± 5.0 events/h, P = 0.01). Data on HRV were available in 15 patients. A higher low/high frequency ratio, either in the 4-h (3.8 ± 2.6 vs 2.9 ± 1.7, P = 0.04, PEEP vs no PEEP, respectively) or in the 5-min segments (2.6 ± 1.8 vs 1.45 ± 0.9 P = 0.01) was found during PEEP administration.

Conclusion: In ALS patients, PEEP application during NIV was associated with worse NIV and sleep quality and with higher sympathetic activity.

Keywords: amyotrophic lateral sclerosis; heart rate variability; non-invasive ventilation; positive end-expiratory pressure; sleep quality.

 

背景と目的。筋萎縮性側索硬化症(ALS)患者における非侵襲的換気(NIV)の設定の違いによる影響を評価した研究はない。我々は、換気治療を受けていないALS患者において、換気の有効性、睡眠構造、心拍変動(HRV)に及ぼす呼気終末陽圧(PEEP)の影響を検討した。

方法。2夜連続で25人の患者を対象に、同レベルの総陽吸気圧で夜行性NIV(Idea Ultra ResMed)投与中に0または4cm H2 0のPEEPをランダムな順序で投与した。睡眠とNIVの質、およびHRVを評価するために、ポリソムノグラフィーを実施しました。HRVは、4時間睡眠時と安定したNREM睡眠時の5分間のセグメントで解析しました。

結果。睡眠時のガス交換には、PEEPの有無による違いは認められませんでした。逆に、PEEP適用時には、リーク(41.4±29.3% vs 31.0±25.7%、P = 0.0007)とオートトリガー(4.2(IQR 1.3-10.0) vs 0.9(IQR 0.0-3.0)イベント/h、P < 0.001、PEEPとPEEPなしの場合、それぞれ)が増加しました。また、N3睡眠段階持続時間は減少(2.5%(IQR 0.0-18.0) vs 0.0%(IQR0.0-12.1)、P = 0.001)し、覚醒・覚醒指数は増加(16.9 ± 7.4 vs 13.4 ± 5.0 イベント/h、P = 0.01)した。HRVに関するデータは15人の患者で得られた。4時間(3.8±2.6 vs 2.9±1.7、P = 0.04、PEEPとPEEPなし、それぞれ)または5分間(2.6±1.8 vs 1.45±0.9、P = 0.01)では、PEEP投与中に低周波/高周波比が高くなっていた。

結論。ALS患者では、NIV中のPEEP投与はNIVと睡眠の質の悪化と交感神経活動の亢進と関連していた。

キーワード:筋萎縮性側索硬化症;心拍変動;非侵襲的換気;正末端呼気圧;睡眠の質。

calendar

S M T W T F S
1234567
891011121314
15161718192021
22232425262728
2930     
<< November 2020 >>

selected entries

categories

archives

recent comment

links

profile

search this site.

others

mobile

qrcode

powered

無料ブログ作成サービス JUGEM