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Nocturnal assisted ventilation using bilevel positive airway pressure: the effect of expiratory positive airway pressure. 1995

M W Elliott, and A K Simonds
Dept of Thoracic Medicine, Royal Brompton National Heart and Lung Hospitals (Chelsea), London, UK.

Increasing expiratory positive airway pressure (EPAP) has theoretical advantages during overnight nasal ventilation. We wanted to evaluate the effect of the addition of EPAP upon the control of nocturnal hypoventilation. Seven patients with neuromuscular/skeletal (NMS) disorder (mean +/- SD forced vital capacity (FVC) 1.06 +/- 0.28 l, arterial oxygen tension (PaO2) 9.1 +/- 0.6 kPa, and arterial carbon dioxide tension (PaCO2) 6.9 +/- 0.9 kPa), and seven patients with chronic obstructive pulmonary disease (COPD) (FEV1 0.46 +/- 0.14 l, PaO2 6.2 +/- 0.6 kPa, and PaCO2 8.4 +/- 1.1 kPa) all underwent full polysomnography on two nights during bilevel positive airway pressure (BiPAP) ventilation, with and without the addition of expiratory positive airway pressure, which was matched to the level of dynamic positive end-expiratory pressure (PEEP) or set at a minimum value of 5 cmH2O. In the group with neuromuscular/skeletal disorders the maximum transcutaneous carbon dioxide tension (PtcCO2) overnight was lower (inspiratory positive airway pressure (IPAP) 8.1 +/- 1.4 kPa, IPAP/EPAP 7.3 +/- 0.9 kPa) and the minimum level of arterial oxygen saturation (SaO2 min) increased (IPAP 77.1 +/- 6.7%, IPAP/EPAP 83.6 +/- 4.2%) when expiratory positive airway pressure was added. There were no differences in mean PtcCO2 or mean oxygen saturation, but sleep quality was worse (non-rapid eye movement (non-REM) sleep IPAP 266 +/- 44 min, IPAP/EPAP 226 +/- 32 min). In the patients with COPD, expiratory positive airway pressure conferred no advantage.(ABSTRACT TRUNCATED AT 250 WORDS)

UI MeSH Term Description Entries
D007385 Intermittent Positive-Pressure Ventilation Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator. BIPAP Biphasic Intermittent Positive Airway Pressure,IPPV,Inspiratory Positive-Pressure Ventilation,Ventilation, Intermittent Positive-Pressure,Biphasic Intermittent Positive Airway Pressure,Inspiratory Positive Pressure Ventilation,Intermittent Positive Pressure Ventilation,Positive-Pressure Ventilation, Inspiratory,Positive-Pressure Ventilation, Intermittent,Ventilation, Inspiratory Positive-Pressure,Ventilation, Intermittent Positive Pressure
D007738 Kyphosis Deformities of the SPINE characterized by an exaggerated convexity of the vertebral column. The forward bending of the thoracic region usually is more than 40 degrees. This deformity sometimes is called round back or hunchback. Hyperkyphosis,Hyperkyphoses,Kyphoses
D008173 Lung Diseases, Obstructive Any disorder marked by obstruction of conducting airways of the lung. AIRWAY OBSTRUCTION may be acute, chronic, intermittent, or persistent. Obstructive Lung Diseases,Obstructive Pulmonary Diseases,Lung Disease, Obstructive,Obstructive Lung Disease,Obstructive Pulmonary Disease,Pulmonary Disease, Obstructive,Pulmonary Diseases, Obstructive
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D011659 Pulmonary Gas Exchange The exchange of OXYGEN and CARBON DIOXIDE between alveolar air and pulmonary capillary blood that occurs across the BLOOD-AIR BARRIER. Exchange, Pulmonary Gas,Gas Exchange, Pulmonary
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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