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Published ahead of print on June 16, 2005, doi:10.1164/rccm.200406-694OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 5, September 2005, 619-624

A more recent version of this article appeared on September 1, 2005
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Submitted on June 1, 2004
Accepted on May 26, 2005

Effects of Different Ventilator Settings on Sleep and Inspiratory Effort in Neuromuscular Patients

Francesco Fanfulla1*, Monica Delmastro2, Angela Berardinelli3, Nadia D'Artavilla Lupo1, and Stefano Nava2

1 Pulmonary Division, S. Maugeri Foundation - Scientific Institute of Montescano IRCCS, Montescano, Italy, 2 Pulmonary Division, S. Maugeri Foundation - Scientific Institute of Pavia IRCCS, Pavia, Italy, 3 Department of Clinical Neurology and Child Psychiatry, C. Mondino Foundation IRCCS, Pavia, Italy

* To whom correspondence should be addressed. E-mail: ffanfulla{at}fsm.it.

Patients with neuromuscular disease (NMD) who require long-term ventilation normally have the ventilation set using empirical daytime parameters. We evaluated arterial blood gases (ABG), breathing pattern, respiratory muscle function and sleep architecture during ventilation with two non-invasive Pressure Support Ventilation (nPSV) settings in 9 NMD patients. The two settings were randomly applied: the usual (US), with the nPSV setting titrated on simple clinical parameters, and the physiological (PHYS), tailored to the patient's respiratory effort. During wakefulness, nPSV significantly improved ABG and minute ventilation and reduced the diaphragmatic pressure-time product, independently of the type of setting (PTPdi/breath spontaneous breathing 5.7±2.4, US 3.2±2, PHYS 3.6±1.6 cmH2O * sec-1, p< 0.001). However, during sleep, nPSV the PHY resulted in a significant improvement of gas exchange, sleep efficiency (71.7%±14 US vs. 80.6%±8.3 PHY p<0.01) and % of REM sleep (9.1%±7 US vs. 17.3%±5.4 PHY p<0.01). This improvement was significantly correlated with the reduction in ineffective efforts. In NMD, nPSV is effective in improving daytime ABG and in unloading inspiratory muscles independently of whether it is set on the basis of the patient's comfort or the patient's respiratory mechanics. However, PHYS was associated with better sleep architecture and nighttime gas exchange.
Key words: Mechanical ventilation, polysomnography, sleep, respiratory failure, sleep hypoventilation




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