Advanced experience with long-term noninvasive ventilation and late-breaking abstracts

printing supported by . Visit Chiesi at Stand B2.10 MONDAY, SEPTEMBER 3RD 2012 [non-respiratory component of APACHE III score, mean systemic arterial blood pressure, comorbidities (“acute” for GCS, “acute” for KMS)]. Conclusions: The use of KMS resulted in greater clinical usefulness (correlation with outcome and with earlier ABG changes) than that of GCS to assess and monitor sensorium status in HE patients during NIV. Both scores are influenced by pulmonary and extra-pulmonary factors. P2066 Respiratory events during long term noninvasive positive pressure ventilation in children: Clinical implications and detection of events Valeria Calderelli1,2, Jean Christian Borel3, Sonia Khirani4, Adriana Ramirez5, Renato Cutrera6, Jean Louis Pepin3, Brigitte Fauroux2,4. 1Dipartimento di Clinica Pediatrica, Università degli Studi di Ferrara, Italy; 2Pediatric Pulmonary Department, AP-HP, Armand Trousseau Hospital, Paris, France; 3INSERM ERI17, HP2 Laboratory, Grenoble University Hospital, Grenoble, France; 4Inserm UMR S-938, UPMC University Paris 06, France; 5Technical Department, ADEP Assistance, Suresnes, France; 6UOC Broncopneumologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy Objective: The aims of the study were (1) to describe the respiratory events during noninvasive positive pressure ventilation (NPPV) and, (2) to analyze the clinical consequences. Method: Nocturnal polygraphic (PG) recordings were performed in stable patients. Respiratory events were scored using the SomnoNIV Group definitions [1]. The consequences of an event i.e. a fall of ≥ 3% of pulse oximetry (SpO2) and/or a ≥ 30% decrease in pulse rate amplitude (respiratory autonomic micro-arousals: RAM) were described. Results: PG tracings of 27 patients (13 boys, age range 1-18) were analysed: neuromuscular disease (n=7), obstructive sleep apnea (n=8) and lung disease (n=12). Unintentional leaks, partial or total upper airway obstruction without reduction of ventilatory drive, a decrease in ventilatory drive, mixed events, and patient ventilator asynchronies were observed in 61%; 37%; 28%; 7%; 53% of the patients, respectively. These events were associated with a decrease of SpO2 in 21%; 37%; 18%; 4%; 12% of the patients respectively, and with a RAM in 38%; 27%; 8%; 3%; 32% of the patients respectively. The mean number of type of events per patient was 1.8±1.1. For a given patient, there was a predominant event representing 87±10% of total time with respiratory events. The median duration spend in respiratory event was 39% (range 0.7 to 92%) of total recording time. Of the patients with a minimal nocturnal SpO2 >90% and a PtcCO2 <50mmHg, 12 (44%) had at least one respiratory event. Conclusion: Respiratory events are common in stable children treated with long term NPPV and can be associated with desaturations and/or RAM. 1. Gonzalez J et al. Thorax 2011. P2067 Polysomnographic criteria to assess the efficacy of noninvasive ventilation in chronic respiratory failure Roomila Naeck1, Adrianna Portmann2, Ubiratan Freitas1, Dounia Bounoiare1, Florence Portier2, Christophe Letellier1, Jean-François Muir2, Antoine Cuvelier2. 1CORIA UMR CNRS 6614, Rouen University, Saint Etienne du Rouvray, France; 2Pulmonary & Respiratory Intensive Care Department, Rouen University, Rouen, France Aim: We performed successive polysomnographies (PSG) under spontaneous breathing (SB) and under noninvasive ventilation (NIV) in order to assess the improvements of ventilation and sleep in patients with severe chronic respiratory failure. Methods: 12 patients indicated to domiciliary NIV because of chronic respiratory failure (neuromuscular disease (n=4), obesity-hypoventilation syndrome (n=6) or thoracic deformation (n=2)) have performed a PSG under SB at day 1, another PSG with the newly implemented NIV at day 2 and therefore a third PSG under NIV two weeks after (day 15). NIV titration was performed according to local protocols, based on nocturnal oxymetries and morning arterial blood gas assessments. Results: As compared to SB, the oxymetric parameters significantly improved during the first night under NIV. PtcCO2 values, early-morning and diurnal arterial blood gases slightly improved during the first night under NIV but the differences were statistically significant only at day 15. We observed a rapid increase of time spent in REM sleep (9.1±2.1 vs 15.2±2.4% of total sleep time, p=0.0148), a reduction of obstructive apnea index, (28.4±8.6 vs 9.7±4.2, p=0.0175) and the micro-arousal index (40.1±8.5 vs 25.7±1.9, p=0.0258). Heart rate and cardiac variability were significantly reduced under NIV. Patient-ventilator asynchronisms were low in all patients except two and did not significantly vary between day 2 and day 15. Conclusion: NIV efficacy is associated with a rapid and objective improvement of sleep quality, in parallel with a slower improvement of diurnal and nocturnal hypercapnia. Cardiac variability may be also a pertinent parameter to evaluate these patients. P2068 Volume assured pressure support ventilation for chronic ventilatory failure in COPD Sandip Banerjee, Marcus Pittman, Rebecca Chadwick, Atul Gulati, Masood Ali, Michael Davies, Nick Oscroft, Tim Quinnell, Phillipa Lawson, John Shneerson, Ian Smith. Respiratory Sleep and Support Centre, Papworth Hospital NHS Trust, Papworth Everard, Cambridgeshire, United Kingdom Introduction & methods: Non-invasive ventilation (NIV) is used to treat chronic ventilatory failure complicating chronic obstructive pulmonary disease (COPD). This randomised prospective study compared the effectiveness of a volume assured pressure support ventilator (VAPS iVAPS, Resmed) with a pressure controlled ventilator (PCV NIPPY 3, B&D Electromedical) in this patient group. Results: Forty subjects (19 male) were recruited with these demographics (mean & standard deviation): age 66.9 (8.2) years; BMI 28.2 (7.0); smoking 46.5 (31.3) pack years; FEV1 27 (10.2) % predicted. They were randomised 20 to each treatment limb and at baseline there were no differences between the two groups. Outcomes pre-treatment and at 1-month (p values compared to pre-treatment values) Pre-treatment 1 Month P value Mean overnight oxygen saturations (%) PCV 84.4 89.65 0.04 VAPS 85.9 90.53 0.02 Daytime PaCO2 (kPa) PCV 8.13 7.05 0.001 VAPS 8.15 6.67 0.003 Daytime PaO2 (kPa) PCV 7.05 7.87 0.279