Volume Targeted Algorithms. Are they a one-size-fits-all approach to noninvasive ventilation?

Abstract

Noninvasive ventilation (NIV) has rapidly expanded as the principle respiratory support strategy in a variety of disease states ultimately resulting in respiratory insufficiency including COPD, overlap syndrome (COPD + comingled sleep disordered breathing), obesity hypoventilation syndrome (OHS), motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), as well as various muscular dystrophies to list just a few examples. In recent years, NIV technology and algorithms have experienced rapid development aimed at improving performance, reliability, comfort, portability, titration efficiency, and treatment outcomes. One specific algorithmic advancement of NIV has been the development of volume targeting algorithms and the creation of new, hybrid modes of NIV. The fundamental feature of volume targeted algorithms is the automation of the inspiratory positive airway pressure (IPAP) or pressure support (PS). In recent years, volume targeted modes have grown in popularity and often are the preferred method of implementing NIV in the home. There are important differences between manufacturer’s proprietary algorithms that should be understood by the clinician when implementing NIV or when evaluating patient response to NIV. This article will identify some of the unique characteristics of commercially available volume targeted modes and will provide an overview of recent findings in specific cohorts. Keywords: non-invasive ventilation (NIV), volume-targeted ventilation, volume assured pressure support, chronic obstructive pulmonary disease (COPD), neuromuscular disorders (NMD)