Respiratory investigation · 2026
Volume-assured pressure support versus bilevel positive airway pressure in non-invasive ventilation: A systematic review of clinical effectiveness.
СтатьяСистематический обзорСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Srivali Narat, De Giacomi Federica
Аннотация
BACKGROUND: Volume-assured pressure support (VAPS) modes automatically adjust inspiratory pressure to maintain target ventilation, theoretically improving upon traditional bilevel positive airway pressure (BiPAP). However, their comparative effectiveness across different clinical contexts remains incompletely characterized.
METHODS: We systematically reviewed MEDLINE, EMBASE, and Cochrane databases through May 2025, comparing VAPS with BiPAP. Studies were stratified a priori by clinical setting (acute vs chronic/stable) due to differing CO2 dynamics.
PRIMARY ENDPOINTS: blood gas parameters, particularly PaCO2). Secondary endpoints included clinical success rates, patient comfort, adherence, and mortality.
RESULTS: Fifteen studies (763 participants) were analyzed. In acute settings, VAPS demonstrated faster PaCO2 correction in two studies (0.18 kPa/h faster, p < 0.001; 83.3% vs 66.6% normalization at 30 min, p = 0.015); four showed equivalent response. Intubation rates favored VAPS in hypercapnic failure (6.4% vs 15.2%) but a single study (n = 89) suggested potential harm in hypoxemic failure (60% vs 42%, p > 0.05). In chronic settings, both modes achieved equivalent gas exchange (six of seven studies). Patient adherence predicted survival better than mode selection (HR 0.34, 95% CI: 0.18-0.64).
CONCLUSIONS: These hypothesis-generating findings show VAPS provides faster early stabilization in acute hypercapnic respiratory failure and equivalent outcomes in chronic stable conditions. However, substantial within-strata heterogeneity limits granular guidance, particularly in chronic settings combining mechanistically distinct diseases (Chronic obstructive pulmonary disease, Obesity hypoventilation syndrome, neuromuscular disorders). The intubation difference in hypoxemic failure (single study, n = 89) requires replication. Disease-specific randomized trials are needed before definitive recommendations.
METHODS: We systematically reviewed MEDLINE, EMBASE, and Cochrane databases through May 2025, comparing VAPS with BiPAP. Studies were stratified a priori by clinical setting (acute vs chronic/stable) due to differing CO2 dynamics.
PRIMARY ENDPOINTS: blood gas parameters, particularly PaCO2). Secondary endpoints included clinical success rates, patient comfort, adherence, and mortality.
RESULTS: Fifteen studies (763 participants) were analyzed. In acute settings, VAPS demonstrated faster PaCO2 correction in two studies (0.18 kPa/h faster, p < 0.001; 83.3% vs 66.6% normalization at 30 min, p = 0.015); four showed equivalent response. Intubation rates favored VAPS in hypercapnic failure (6.4% vs 15.2%) but a single study (n = 89) suggested potential harm in hypoxemic failure (60% vs 42%, p > 0.05). In chronic settings, both modes achieved equivalent gas exchange (six of seven studies). Patient adherence predicted survival better than mode selection (HR 0.34, 95% CI: 0.18-0.64).
CONCLUSIONS: These hypothesis-generating findings show VAPS provides faster early stabilization in acute hypercapnic respiratory failure and equivalent outcomes in chronic stable conditions. However, substantial within-strata heterogeneity limits granular guidance, particularly in chronic settings combining mechanistically distinct diseases (Chronic obstructive pulmonary disease, Obesity hypoventilation syndrome, neuromuscular disorders). The intubation difference in hypoxemic failure (single study, n = 89) requires replication. Disease-specific randomized trials are needed before definitive recommendations.