Noninvasive volume-assured pressure support for chronic respiratory failure: a review. Issue 6 (November 2019)

• Record Type: Journal Article
• Authors: Shaughnessy, Gaja F.; Gay, Peter C.; Olson, Eric J.; Morgenthaler, Timothy I.
• Is Part Of: Current opinion in pulmonary medicine. Volume 25:Issue 6(2019:Nov.)
• Publication Date: 2019-11
• Subjects: chronic respiratory failure -- noninvasive ventilation -- volume-assured pressure support; Respiratory organs -- Diseases -- Periodicals; 616.24
• DOI: 10.1097/MCP.0000000000000605
• Languages: English
• ISSNs: 1070-5287

Abstract

Abstract : Purpose of review: Noninvasive ventilation (NIV) is an established treatment for chronic hypercapnic respiratory failure (CRF). Volume-assured pressure support (VAPS) is a mode of NIV that automatically adjusts inspiratory pressure in order to maintain a constant respiratory volume. We aim to discuss the role and application of VAPS in CRF. Recent findings: Recently published meta-analyses and reviews fail to demonstrate a significant difference in gas exchange, sleep, or quality-of-life improvement between VAPS and bilevel positive airway pressure (BPAP) in patients with CRF. A recent manuscript suggests that VAPS therapy in chronic obstructive pulmonary disease patients may reduce the number of exacerbations. It has been shown that with a protocol-driven approach BPAP and VAPS can both be successfully titrated during a single split-night polysomnography. Summary: VAPS is as effective as other modes of NIV at improving ventilation and sleep in CRF. The potential advantage is a more consistent ventilatory support through daytime–nighttime variations and progression of disease over time. However, the impact on long-term outcomes, such as survival, has not been studied.