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Autotitrating versus standard noninvasive ventilation: a randomised crossover trial

¹ Sleep and Ventilation Unit, Royal Brompton Hospital, and ² Clinical and Academic Unit of Sleep and Breathing, National Heart and Lung Institute, London, UK.

CORRESPONDENCE: J. Jaye, Sleep and Ventilation Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. Fax: 44 2073518911. E-mail: j.jaye{at}rbht.nhs.uk

Keywords: Automatic titration, chest wall disorders, neuromuscular disease, nocturnal hypoventilation, noninvasive ventilation

Received: April 28, 2008
Accepted September 13, 2008

The aim of the present study was to compare the efficacy of automatic titration of noninvasive ventilation (NIV) with conventional NIV in stable neuromuscular and chest wall disorder patients established on long-term ventilatory support.

In total, 20 neuromuscular and chest wall disease patients with nocturnal hypoventilation treated with long-term NIV completed a randomised crossover trial comparing two noninvasive pressure support ventilators: a standard bilevel ventilator (VPAP III) and a novel autotitrating bilevel ventilator (AutoVPAP). Baseline physiological measurements, overnight polysomnography and Holter monitoring were repeated at the end of each 1-month treatment period.

Nocturnal oxygenation was comparable between the autotitrating device and standard ventilator, as were sleep efficiency, arousals and heart rate variability. However, there was a small significant increase in mean overnight transcutaneous carbon dioxide tension (median (interquartile range) 7.2 (6.7–7.7) versus 6.7 (6.1–7.0) kPa) and a decrease in percentage stage 1 sleep (mean±SD 16±9 versus 19±10%) on autotitrating NIV compared with conventional NIV.

Autotitrating noninvasive ventilation using AutoVPAP produced comparable control of nocturnal oxygenation to standard nonivasive ventilation, without compromising sleep quality in stable neuromuscular and chest wall disease patients requiring long-term ventilatory support for nocturnal hypoventilation.