Volume-targeted non-invasive ventilation in individuals with slowly progressive neuromuscular disease: effect on sleep and ventilatory control

Individuals with chronic respiratory failure secondary to slowly-progressive neuromuscular diseases (NMD) commonly receive fixed-pressure non-invasive ventilation (Fp-NIV), with variable ventilatory control and adherence. We assessed if volume-targeted NIV (Vt-NIV) would improve ventilation and sleep quality. A 2-night study compared Fp-NIV (night 1) with Vt-NIV (night 2) in individuals with slowly-progressive NMD using the Nippy 4+ (Breas Medical). Target tidal volume was the higher of 8–10 ml/kg ideal body weight or 15% above night 1’s mean tidal volume. Overnight oxi-capnometry assessed mean and maximal transcutaneous carbon dioxide (TcCO2) and oxygen saturation. After each night, participants scored sleep quality, comfort, and ventilator coordination on a ten-point Likert scale. Data presented as median (IQR). 19 individuals were included (63% male, age 41 (23–63) yrs). Daytime TcCO2 was 5.4 (5.1–5.7) kPa. Fp-NIV settings were IPAP 18 (14–24) cmH2O, EPAP 6 (4–8) cmH2O, BUR 16 (14–16) bpm, Ti 1.3 (1.2–1.4) secs. For Vt-NIV, target volume was 550 (460–650)ml. Vt-NIV improved subjective sleep quality and TcCO2 (Figure 1). Oxygenation was unchanged. Vt-NIV improved ventilatory control and subjective sleep quality in individuals with slowly-progressive NMD. Its impact on long-term NIV adherence and health-related quality of life warrants further study. erjor;12/suppl_17/98/F1 F1 F1