Full-Face versus nasal mask for high intensity noninvasive ventilation in COPD patients with chronic hypercapnic respiratory insufficiency– a randomized crossover trial –

Abstract

Background: To compare the impact of full-face (FFM) and nasal masks (NM) for guaranteeing nocturnal high-intensity non-invasive positive pressure ventilation (Hi-NPPV) with focus on gas exchange and sleep quality in chronic hypercapnic COPD. Methods: In a randomized cross-over trial 30 COPD patients (mean age 64,9±8,78, mean FEV1 33,47±12,91 ) with well-established HI-NNPV were measured for two consecutive nights using full polysomnography, transcutaneous PCO2 monitoring and subjective assessments. FFM and NM were randomly assigned while ventilator settings remained unchanged. All patients were using Hi-NPPV at home for at least one month, prior to inclusion. Primary outcome was sleep efficiency. Results: Mean ventilator settings were as follows: IPAP 26±3 cmH2O, EPAP 5±1 cmH2O, respiratory rate 17±1 /min) There was a clear trend for a better sleep efficiency (primary outcome) when using a FFM (60.4±19.6 % vs. 50.5±24.9 %, P=0.054). Sleep stages 3/4 were in favor of FFM (34.2%±21.4 % vs. 22.9%±18.6 %, P=0.03). Mean transcutaneous PCO2 was comparable: 48.9±6.6 mmHg (NM) vs. 47.7±7.4 mmHg (FFM), P=0.3). Subjective evaluation of patients’ satisfaction showed no clear trend for favoring NM or FFM, respectively, even though leakage was subjectively less when using a NM. Conclusion: Both NM and FFM are capable of successfully delivering HI-NNPV. FFM, however, is superior over NM concerning sleep quality, but this would need to be balanced against subjective leak occurrence. Method: COPD; Non-invasive Ventilation, HI-NPPV, respiratory insufficiency, hypercapnia