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Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!
- Source :
- Respiratory Research, Respiratory Research, 2020, 21, pp.243. ⟨10.1186/s12931-020-01509-7⟩, Respiratory Research, BioMed Central, 2020, 21, pp.243. ⟨10.1186/s12931-020-01509-7⟩, Respiratory Research, Vol 21, Iss 1, Pp 1-13 (2020)
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p p = 0.002) and ASV-V (p Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.
- Subjects :
- Male
Cardiac output
030204 cardiovascular system & hematology
[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
Tidal volume
0302 clinical medicine
Lead (electronics)
2. Zero hunger
Sleep Apnea, Obstructive
Ejection fraction
Continuous Positive Airway Pressure
Setting
3. Good health
embryonic structures
Breathing
Cardiology
Female
medicine.symptom
medicine.medical_specialty
animal structures
Adaptive servo-ventilation
03 medical and health sciences
Sleep Apnea Syndromes
Internal medicine
Hyperventilation
Pressure
medicine
Humans
Sleep-disordered breathing
Aged
lcsh:RC705-779
business.industry
Research
lcsh:Diseases of the respiratory system
Respiration, Artificial
Sleepdisordered breathing
Cardiopathy
Cross-Sectional Studies
030228 respiratory system
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
Cluster
[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
Minute volume
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Pulmonary Ventilation
business
Body mass index
Respiratory minute volume
Follow-Up Studies
Subjects
Details
- ISSN :
- 1465993X and 14659921
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Respiratory Research
- Accession number :
- edsair.doi.dedup.....e89c5c96036cec71d996aaa25c293b01