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
Objectives: The primary goal of this study was to compare patient satisfaction between
bi-level positive airway pressure-spontaneous/timed with average volume assured pressure
support (BiPAP S/T with AVAPS) and BiPAP S/T alone in patients with acute exacerbations
of chronic obstructive pulmonary disease (AECOPD) using self-reported intensity of dyspnea
measured with the modified Borg scale (MBS) and a numeric rating scale (NRS) and comfort
level measured with a dyspnea and comfort scale.
Methods: This pilot randomized clinical study was conducted in patients who presented
with 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 in
the MBS, the NRS, and the dyspnea and comfort scale were higher in the group than the control
group (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 in
the AVAPS group (1.64 ± 2.77 vs. 1.09 ± 3.02). However, none of these differences reached
Conclusion: There was no statistically significant improvement in patient comfort using
AVAPS as an adjunct to standard BiPAP S/T therapy in this pilot study.
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