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Subject Area

Pediatrics

Article Type

Original Study

Abstract

Objective The aim of this study was to assess the role of waveforms analysis in optimizing patient–ventilator interactions. Background Ventilator-waveforms analysis may help in optimizing patient–ventilator interactions, especially during noninvasive ventilation (NIV). However, published data on this tool are very limited. Patients and methods A randomized controlled trial was conducted in which 50 patients with acute exacerbation of chronic obstructive pulmonary disease who underwent NIV were randomly allocated to receive either optimized ventilation guided by waveform analysis or standard ventilation. Our primary outcome was pH normalization rate during first 24 h of treatment. Secondary outcomes included physiological response [tidal volume, respiratory rate, and partial pressure of arterial carbon dioxide (PaCO2)], ventilator settings changes (external positive end-expiratory pressure, pressure support, rise time, and inspiratory trigger), patient–ventilator interaction [tolerance and Asynchrony Index (AI)], and major endpoints (NIV success rate, on-ventilator days, length of stay, and mortality rate). Results 'Optimized ventilation' resulted in significantly higher pH normalization rate at 6 h (36% instead of 12%; P = 0.047). PaCO2was decreased significantly at 2 and 6 h (P = 0.032 and 0.008, respectively). This group was characterized by greater external positive end-expiratory pressure, greater inspiratory triggering sensitivity, and lower rise time. In addition, there was a significant improvement in AI after 2 h (P = 0.002), with no significant difference in patient tolerance. Conclusion The usage of waveform analysis during NIV for acute chronic obstructive pulmonary disease exacerbations showed a significantly positive effect in pH normalization rate, PaCO2reduction, and AI improvement.

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