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Effects of positive end expiratory pressure administration during non‐invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study
Author(s) -
Crescimanno Grazia,
Greco Francesca,
Arrisicato Salvo,
Moraoemi,
Marrone Oreste
Publication year - 2016
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12836
Subject(s) - medicine , crossover study , amyotrophic lateral sclerosis , anesthesia , ventilation (architecture) , non rapid eye movement sleep , cardiology , positive end expiratory pressure , polysomnography , positive airway pressure , mechanical ventilation , apnea , obstructive sleep apnea , placebo , electroencephalography , mechanical engineering , alternative medicine , disease , pathology , psychiatry , engineering
Abstract Background and objective No studies have evaluated the impact of different settings of non‐invasive ventilation (NIV) in patients affected by amyotrophic lateral sclerosis (ALS). We explored consequences of positive end‐expiratory pressure (PEEP) application on effectiveness of ventilation, sleep architecture and heart rate variability (HRV) in patients with ALS naïve to ventilatory treatment. Methods In two consecutive nights, 25 patients received in random order 0 or 4 cm H 2 0 of PEEP during nocturnal NIV administration (Idea Ultra ResMed) with the same level of total positive inspiratory pressure. Polysomnographies were performed to evaluate sleep and NIV quality, as well as HRV. HRV was analyzed on 4‐h periods and on 5‐min segments of stable NREM sleep. Results We did not observe differences in gas exchanges during NIV with and without PEEP. Conversely, during PEEP application increases in leaks (41.4 ± 29.3% vs 31.0 ± 25.7%, P = 0.0007) and in autotriggerings (4.2 (IQR 1.3–10.0) vs 0.9 (IQR 0.0–3.0) events/h, P < 0.001, PEEP vs no PEEP, respectively) occurred. Besides, N3 sleep stage duration decreased (2.5% (IQR 0.0–18.0) vs 0.0% (IQR0.0–12.1), P = 0.001) and arousal/awakening index increased (16.9 ± 7.4 vs 13.4 ± 5.0 events/h, P = 0.01). Data on HRV were available in 15 patients. A higher low/high frequency ratio, either in the 4‐h (3.8 ± 2.6 vs 2.9 ± 1.7, P = 0.04, PEEP vs no PEEP, respectively) or in the 5‐min segments (2.6 ± 1.8 vs 1.45 ± 0.9 P = 0.01) was found during PEEP administration. Conclusion In ALS patients, PEEP application during NIV was associated with worse NIV and sleep quality and with higher sympathetic activity.