Effect of non-invasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease with acute exacerbation: A randomized pilot trial

Abstract

Objectives: The primary goal of this study was to compare patient satisfaction betweenbi-level positive airway pressure-spontaneous/timed with average volume assured pressuresupport (BiPAP S/T with AVAPS) and BiPAP S/T alone in patients with acute exacerbationsof chronic obstructive pulmonary disease (AECOPD) using self-reported intensity of dyspneameasured with the modified Borg scale (MBS) and a numeric rating scale (NRS) and comfortlevel measured with a dyspnea and comfort scale.Methods: This pilot randomized clinical study was conducted in patients who presentedwith acute respiratory distress due to AECOPD to the Siriraj Hospital Emergency Department.Included patients were randomized in a 1:1 ratio to receive either BiPAP S/T with AVAPS(intervention) or BiPAP S/T (control). MBS, NRS, dyspnea and comfort scale, clinical information,and laboratory results were recorded and analyzed.Results: Twenty-two patients were enrolled (11 in each group). The average decrease inthe MBS, the NRS, and the dyspnea and comfort scale were higher in the group than the controlgroup (4.09 ± 1.81 vs. 2.91 ± 1.64; 4.09 ± 1.76 vs. 2.91 ± 1.92; 3.27 ± 2.45 vs. 3.00 ± 1.90,respectively). The average increase of patient satisfaction with overall comfort was higher inthe AVAPS group (1.64 ± 2.77 vs. 1.09 ± 3.02). However, none of these differences reachedstatistical significance.Conclusion: There was no statistically significant improvement in patient comfort usingAVAPS as an adjunct to standard BiPAP S/T therapy in this pilot study.