Automatic adjustment of noninvasive pressure support with abilevel home ventilator in patients with acute respiratory failure: afeasibility study

Objective: To test the feasibility of applying noninvasive ventilation (NIV) using aprototype algorithm implemented in abilevel ventilation device designed to adjust pressure support (PS) to maintain aclinician-set alveolar ventilation in patients with acute respiratory failure after initial stabilization. Design and setting: Prospective crossover interventional study in an intensive care unit, university hospital. Patients: 19 patients receiving NIV for acute hypercapnic respiratory failure (13 men, 6 women; mean age 70 ± 11 years). Methods: The same bilevel ventilator was used with manually adjusted PS and with the automated algorithm (autoPS), set to maintain the same alveolar ventilation as in PS. Sequence (measurements at end of each period): (a) prior to initiating NIV (baseline 1); (b) 45 min with manually set PS; (c) 60 min without NIV; (d) 45 min with autoPS; (e) 60 min without NIV; (f) 45 min with manually set PS. Results: The magnitude of decrease in PaCO2 and increase in pH with autoPS was comparable to that of conventional PS, with the same alveolar ventilation and level of PS. No technical problem occurred in autoPS mode, and no NIV trial had to be discontinued because of patient discomfort. Conclusions: These results suggest that the alveolar ventilation based automatic control of PS during NIV with abilevel device is feasible and leads to beneficial effects in patients with acute respiratory failure comparable to those of manually set PS. Further studies should now explore the potential of this system over longer periods in patients with acute and chronic respiratory failur