Comparison of Pressure Support and Pressure Control Ventilation in Chronic Respiratory Failure
Comparison of Pressure Support and Pressure Control Ventilation in Chronic Respiratory Failure
This study is looking at whether there is a difference in outcomes using two different types
 of breathing support in those patients who have chronic respiratory failure (patients who
 under-breathe).

 There is little data to demonstrate which mode of ventilation is better in terms of
 physiological outcomes and outcome data relating to patient symptoms.

 We hypothesize that one type of breathing support: pressure support ventilation would be more
 comfortable for patients as it more closely matches a patient's own respiratory pattern and
 and so leads to improved adherence and consequent improvement in quality of life.

 Patients with respiratory failure will be randomly assigned to receive either pressure
 support ventilation or pressure control ventilation for the first 6 weeks and then cross-over
 to receive the mode not previously used for a further 6 weeks. They will have baseline data
 recorded and then be followed up after each 6 week block.
Inclusion Criteria:

 -  Patients with chest wall deformity, neuromuscular disease or obesity hypoventilation
 syndrome with an FEV1/FVC ratio of >70% and VC <50% predicted or patients with COPD
 with a FEV1/FVC ratio of <70% an FEV1 <50% predicted

 -  Stable

 -  pH >7.35

 -  ESS <18

 -  Symptomatically stable with clinical resolution of intercurrent infection: normal
 C reactive protein, white cell count and afebrile

 -  Daytime symptoms compatible with nocturnal hypoventilation i.e. poor sleep, morning
 headache, daytime somnolence, shortness of breath

 -  Arterial carbon dioxide partial pressure (PaCO2) > 6.0kPa during day with evidence of
 nocturnal hypoventilation (TcCO2 >7.5KPa or a rise in TcCO2 of >1 KPa)

 -  No prior domiciliary ventilation use

 -  Patients with COPD must be established on optimal medical treatment prior to enrolment

 Exclusion Criteria:

 -  Psychological, social or geographical situation that would impair compliance with the
 schedule

 -  Patients who have underlying malignancy or severe cardiac dysfunction (ejection
 fraction <40%)

 -  Complex OSA