RT Journal Article
SR Electronic
T1 Changes in patient ventilator asynchrony (PVA) with 3 months home mechanical ventilation (HMV) therapy
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2464
VO 42
IS Suppl 57
A1 Michelle Ramsay
A1 Swapna Mandal
A1 Eui-Sik Suh
A1 Joerg Steier
A1 Anita Simonds
A1 Nicholas Hart
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P2464.abstract
AB Introduction:PVA adversely affects respiratory muscle unloading and we hypothesised that this contributes to reducing patient adherence to HMV.Methods:Patients admitted for initiation of HMV were enrolled and titrated using capnography and oximetry.We measured parasternal electromyography as a marker of neural respiratory drive, respiratory plethysmography and airway pressure waveforms to characterise PVA non-invasively. Measurements were collected at baseline and 3 months. PVA was scored by our standard definitions and expressed as percentage of total breaths analysed.Results:15 patients(8 male) participated; 7 neuromuscular disease(NMD), 5 chronic obstructive pulmonary disease(COPD) and 3 obesity hypoventilation syndrome(OHS). 29,531 breaths were analysed. Overall, PVAs affected 28% of breaths at baseline dropping to 23% breaths at 3 months. Initially OHS patients had higher levels of PVA followed by COPD and NMD patients. In OHS patients PVAs reduced by 19% at 3 months whilst in COPD and NMD PVAs increased by 0.9% and 3.5% respectively. Median daily ventilator adherence at 3 months was 6:42h(1:29-7:40), no significant correlation was found between change in PVAs and adherence to HMV (r=-0.2, p=0.5).Conclusion:PVA did not change significantly with 3 months HMV therapy. The incidence of PVA remains high at 3 months, albeit with a fall in the OHS group; changes in PVA were not related to ventilator adherence.