Late Breaking Abstract - Adaptive strategy for EPAP of non-invasive ventilation to AECOPD patients with heart failure

Background: Benefits of AVAPS-AE(average volume assured pressure support auto-titrating EPAP) mode in AECOPD patient with heart failure(HF) has remained unclear. Objectives: To assess efficacy of AVAPS-AE for AECOPD patients with HF and optimize the strategy for EPAP level. Methods: A prospective, randomized, controlled and clinical trial,75 elderly(76±8.3yrs) AECOPD patients were included, who complicated with HF (NYHA≥Ⅱ, NT-proBNP≥1800pg/ml)and had a history of coronary artery disease. All subjects were randomly divided into 3 groups(25 in each group): CPAP(continuous positive airway pressure) group, AVAPS group and AVAPS-AE group. Settings: EPAP=8cmH2O in CPAP group, EPAP=8cmH2O in AVAPS group, EPAPmin =4cmH2O and EPAPmax =14cmH2O in AVAPS-AE group，other parameters were similar. Results: Compared with CPAP and AVAPS group, there were greater reduction in area of lung CT infiltration and BNP level in AVAPS-AE group(p<0.001), significant improvement of Borg Score and HRQL(health-related quality of life) in AVAPS-AE group(p<0.01). The blood PCO2 and A-aDO2 decreased,PO2 increased significantly in AVAPS-AE group(p<0.05), other outcomes were recorded (Fig1). Conclusions: AVAPS-AE mode maybe lead to significant improvement in clinical outcomes of AECOPD with HF by supplying with auto-titrating EPAP, the adaptive strategy for EPAP should be a varying and dynamic scale rather than a fixed parameter, during NIV.