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Patient-Ventilator Interactions in Chronic Obstructive Pulmonary Diseases (COPD) Under Non-Invasive Ventilation

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ClinicalTrials.gov Identifier: NCT01180439
Recruitment Status : Completed
First Posted : August 12, 2010
Last Update Posted : August 12, 2010
Sponsor:
Information provided by:
Ligue Pulmonaire Genevoise

Study Description
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Brief Summary:

Non-invasive ventilation (NIV) in severe hypercapnic Chronic Obstructive Pulmonary Diseases (COPD) may be associated - during sleep - with recurrent episodes of patient ventilatory asynchrony, which in turn may affect quality of sleep, efficacy of ventilation and comfort of nocturnal NIV.Polysomnography (PSG) under NIV is necessary to detect these events.

Adjusting ventilator settings according to respiratory events detected by PSG with NIV may improve quality of sleep, efficacy of ventilation and comfort of nocturnal NIV.


Condition or disease Intervention/treatment Phase
Chronic Obstructive Pulmonary Disease Device: Adjustment of ventilator settings (device) Not Applicable

Detailed Description:

Patients under NIV for hypercapnic COPD have several reasons to develop patient-ventilatory asynchrony: delayed cycling, and insufficient expiratory time may induce progressive dynamic hyperinflation, and increase intrinsic positive end-expiratory pressure (PEEPi); too high levels of pressure support may also contribute to dynamic hyperinflation. Increase in PEEPi is associated with two respiratory events: unrewarded inspiratory efforts, and auto-triggering.

Our hypotheses are: 1/that these events occur frequently in COPD under NIV and that they are not detected by medical history or usual monitoring tools (SpO2; PtcCO2); 2/ that they can be easily detected by polysomnography; 3/ that simple adjustments of ventilator parameters aiming to reduce dynamic hyperinflation and unrewarded inspiratory efforts may improve efficacy of ventilation, quality of sleep and comfort of treatment.

The present study compares the results of two consecutive sleep studies: 1.PSG under NIV in severe stable COPD under "usual ventilator settings" with 2.PSG under NIV after adapting ventilator settings to results of initial PSG.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Patient-Ventilator Interactions During Sleep Under Non-Invasive Ventilation in Severe Stable COPD
Study Start Date : October 2009
Actual Primary Completion Date : August 2010
Actual Study Completion Date : August 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: COPD Lung Diseases

Arms and Interventions
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Intervention Details:
  • Device: Adjustment of ventilator settings (device)
    Decrease in pressure support, increase in respiratory back-up rate, increase in expiratory positive airway pressure (EPAP) to counteract effect of PEEPi, and adjustment of cycling (at higher percentage of peak inspiratory flow)

Outcome Measures
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Primary Outcome Measures :
  1. Subjective evaluation of efficacy of nocturnal ventilation after adjusting ventilator settings [ Time Frame: one night ]
    Visual analogic scale (VAS) of morning dyspnea, and questionnaire evaluating 8 items of comfort of ventilation (Janssens JP et al; Impact of volume targeting on efficacy of bi-level non-invasive ventilation and sleep in obesity-hypoventilation; Respir Med 2009 Feb;103(2):165-72)


Secondary Outcome Measures :
  1. Objective evaluation of efficacy of ventilation after adjustment of ventilator settings [ Time Frame: one night ]
    Analysis of leaks, estimated ventilation, SpO2, TcPCO2, sleep structure, and patient-ventilatory synchronisation and comparison with data under "usual settings" for ventilator


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • COPD, with chronic hypercapnic respiratory failure, treated by NIV, in stable clinical condition, aged above 18 years

Exclusion Criteria:

  • Unstable clinical condition
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01180439


Locations
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Switzerland
Division of Pulmonary Diseases; Geneva University Hospital
Geneva 11, Geneva, Switzerland, 1211
Division of Pulmonary Diseases; Geneva University Hospital
Geneva 14, Geneva, Switzerland, 1211
Sponsors and Collaborators
Ligue Pulmonaire Genevoise
Investigators
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Study Director: Jean-Paul Janssens, MD Division of Pulmonary Diseases; Geneva University Hospital
More Information
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Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Dan Adler, MD, Division of Pulmonary Diseases, Geneva University Hospital
ClinicalTrials.gov Identifier: NCT01180439    
Other Study ID Numbers: CE 09-047
First Posted: August 12, 2010    Key Record Dates
Last Update Posted: August 12, 2010
Last Verified: August 2010
Keywords provided by Ligue Pulmonaire Genevoise:
Non-invasive ventilation
Chronic Obstructive Pulmonary Disease
Patient-ventilator synchronisation
Sleep study
Polysomnography
Additional relevant MeSH terms:
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Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Respiratory Tract Diseases