Abstract
Background: In the SERVE-HF study, an increased risk of mortality was found in heart failure patients under adaptive servoventilation (ASV). Among other things, it was believed to be a device algorithm-based effect.
A study of patients with complex sleep apnea (TECSA) and normal cardiac function compared 4 different ASV devices (Knittel et al AJRCCM 1/2019). There was a significant difference in measured ventilation with the device used in the SERVE HF study. Thus, this excessive ventilation could be a device and not a class effect. W. Randerath discussed whether the minimum pressure support (PSmin) of 3cmH2O via a respiratory alkalosis results in a pro-arrhytmogene effect (Pneumology 2019; 73: 665).
Aim: Survey of arterial blood gas (ABG) before and under ASV with regard to hypocapnia.
Method: 226 patients admitted for follow-up of ASV from 10/18 to 05/2020: age 65.2 x 11.3 yrs, BMI 35.7 x 7.5kg/m2, average application 5.6 x 2.5h/d, PSmin 4.8 x 1.8cmWS. Patients with heart failure were excluded, the majority had ASV because of TECSA, very rarely a cardiac or other genesis.
Results: pCO2 (mmHg) pH SBC (mmol/l) pO2 (mmHg) on the day 37.8 x 3.3 7.434 x 0.028 25.4 x 2.0 69.4 x 6.6 under ASV 39.7 x 3.9 7.428 x 0.039 26.2 x 2.4 75.5 x 10.7
In 29 cases hypocapnia was found in the morning with pCO2 < 36 mmHg.
Conclusion: Under ASV we could not determine any class effect of hypocapnia. After all, 12.8% had hypocapnia, some of which is clinically relevant. This may be due to the genesis of the CSR - predominantly TECSA - and our setting values with relatively high PSmin, so that in these cases an ABG should be carried out under ASV.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 4733.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020