Intelligent Volume Assured Pressure Support (iVAPS) vs. Spontaneous/Timed Mode as a Weaning Strategy for Intubated COPD Patients with Acute Exacerbation

Abstract

Introduction: Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube. Material and methods: This study was conducted to compare the effective-ness of iVAPS versus standard Spontaneous/timed (S/T) mode in facilitating weaning process of mechanically ventilated chronic obstructive pulmonary disease (COPD) in acute exacerbation. In a prospective randomized study, 80 invasively ventilated COPD patients in acute exacerbations were extubated then immediate application of NPPV using either S/T mode (Group I) or iVAPS mode (Group II) was done. Clinical parameters (heart rate, respiratory rate, and arterial blood gas param-eters at selected time intervals of treatment were recorded for both groups and analyzed. Results: No significant differences were found between both groups regarding age, sex, mMRC dyspnea scale, CAT score and APACHE II score. Heart rate and mean arterial blood pressure in the two groups decreased with time, but no significant differences were found between the two groups. Likewise, there was no significant difference in RR between S/T and iVAPS groups. Regarding ar-terial blood gas analysis, there were no detectable differences in PaCO2 level, PaO2 level or oxygen saturation. The successful outcome was achieved in (82.5%) in the S/T group vs (80%) in the iVAPS group. The two modes achieved comparable levels of comfort as assessed by VAS and the total Mask Fitness Score. There was no statistically significant difference in reintubation, the duration of NPPV, duration of ICU stay or in mortality rate. Conclusion: iVAPS mode is as effective as fixed-pressure S/T mode in facilitating weaning of hypercapnic COPD patients.