Clinical characterization and possible pathophysiological causes of the Deventilation Syndrome in COPD

Mavi Dorothea Schellenberg,Marietta Kirchner,Gabriele Iberl,Sandra Imach,Felix Herth,Franziska Trudzinski

doi:10.1038/s41598-022-05118-w

Mavi Dorothea Schellenberg, Marietta Kirchner + Show 4 more

Open Access

https://doi.org/10.1038/s41598-022-05118-w

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Abstract

In daily routine, many COPD patients report early onset augmented dyspnea following use of NIV (Deventilation Syndrome, DVS) as a negative side-effect. The aim of this study is the clinical characterization and concrete definition of DVS. This monocenter prospective observational study collected demographic, physiologic and symptomatic data from 67 in-patients with severe COPD Gold III–IV and chronic hypercapnic failure before, during and after use of an established NIV. During their inpatient follow-up, we examined patients during the first hour after termination of nocturnal NIV. DVS was defined by the authors as an increase of ≥ 2 points on the Borg scale during the first 30 min in patients who reported repeated dyspnea after the use of NIV. We monitored cardiovascular and respiratory data and measured diaphragm excursion. Subjective dyspnea was documented by use of the Borg scale and questionnaires. In addition, respirator and demographic data were collected. DVS occurred in 58% of our COPD patient collective, showing predominant emphysema phenotype. Patients with DVS were more severely ill than non-DVS concerning bronchial obstruction (FEV1 0.6 vs. 0.8 l, p < 0.05) and hypercapnia during spontaneous breathing (pre NIV pCO2: 54.5 vs. 49.3 mmHg, p < 0.02). DVS patients showed significantly higher respiratory rates (RR) (20.1 vs. 18.1/min p < 0.05) after termination of NIV. This trial characterizes and defines early onset augmented dyspnea after the use of NIV, referred to as DVS. It is hereby brought to attention as a frequent side effect of long-term home ventilation and possible pathophysiologic mechanisms are elucidated.

Highlights

Abbreviations BGA Blood gas analysis BP Blood pressure Bpm Breaths per minute CHRF Chronic hypercapnic respiratory failure COPD Chronic obstructive pulmonary disease diaphragm excursion (DE) Diaphragm excursion DVS Deventilation Syndrome ENMG Electroneuromyography EPAP Expiratory positive airway pressure inspiratory/expiratory ratio HR Heart rate IPAP Inspiratory positive airway pressure kHz Kilohertz kPa Kilopascals LTH-NIV Long term home non-invasive ventilation Mbar Millibar MmHg Millimeter of mercury nDVS Non Deventilation Syndrome
This study describes a further, highly burdening side effect: early onset acute dyspnea following the use of NIV—augmented in the morning, and after use during the day
Between November 2016 and January 2019, 71 patients were included in the study

Summary

Introduction

Abbreviations BGA Blood gas analysis BP Blood pressure Bpm Breaths per minute CHRF Chronic hypercapnic respiratory failure COPD Chronic obstructive pulmonary disease DE Diaphragm excursion DVS Deventilation Syndrome ENMG Electroneuromyography EPAP Expiratory positive airway pressure inspiratory/expiratory ratio HR Heart rate IPAP Inspiratory positive airway pressure kHz Kilohertz kPa Kilopascals LTH-NIV Long term home non-invasive ventilation Mbar Millibar MmHg Millimeter of mercury nDVS Non Deventilation Syndrome. Non-invasive positive pressure ventilation (NPPV, NIV) is a widespread therapeutic option for patients with chronic hypercapnic failure due to C OPD1,2. This study describes a further, highly burdening side effect: early onset acute dyspnea following the use of NIV—augmented in the morning, and after use during the day

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