Number of Patients:
Total no. of patients = 40 patients NIV-PSV group (Group A) = 20 NIV-NAVA group (Group B) =
a) Patients of Chronic obstructive pulmonary disease with acute hypercapnic respiratory
failure (pH < 7.35 and PaCO2 >45 mmHg) requiring noninvasive ventilation and with no
indication for invasive mechanical ventilation.
1. Patient with any contra-indication for insertion of nasogastric tube (like recent
gastrointestinal bleeding in previous 30 days, esophageal varices)
2. Patient with any contraindication of noninvasive ventilation (such as hemodynamic
instability, active gastrointestinal bleed etc)
3. Patients with a known neuromuscular, central or peripheral nervous system disorder.
4. Patient not willing to give consent.
Control(s): Patients receiving pressure support ventilation (NIV-PSV) will act as control
Study design: Randomized interventional study
Dosages of drug: None
Duration of treatment: Till patient improves or requires invasive ventilation.
Brief Methodology Patients of COPD with acute exacerbation will be randomized into two groups
(group A and group B) to receive NIV-PSV or NIV-NAVA respectively. A special naso-gastric
catheter (EAdi-catheter) will be placed in all patients. In each mode, NIV will be applied
using a non-vented oro-nasal mask that will be fitted enough to avoid air leaks. Patients in
Group A will receive NIV-PS and Group B will receive ventilation via NIV-NAVA. Pressure
support and PEEP levels will be set by the treating physician to achieve a tidal volume (Vt)
of 6 to 8 mL/kg of ideal body weight. NAVA level will be adjusted to match peak pressures of
NIV-PSV using manufacturer-supplied software. After stabilization, a 30-min period of each
NIV trial will be recorded and manually analyzed offline. Subsequent readings will be taken
at 2, 6 and at 24 hours and then at 6 hourly interval from day 2 onwards. In each trial,
patient-ventilator asynchronies (ineffective efforts, auto triggering, premature cycling,
delayed cycling, and double triggering) will be determined on EAdi, airway pressure, and flow
signal. The number of each type of asynchrony, defined as the number of events per minute,
will be determined for each recording period. The asynchrony index (AI), in percentage, will
be calculated as described previously, and an AI >10% will be considered severe asynchrony.
Patient comfort level after each mode of ventilation will be assessed by using visual
analogue scale. Various clinical, ventilatory and arterial blood gas parameters will be
Statistical analysis Data will be expressed as mean ± standard deviation (SD), or percentage.
Differences in continuous variables between the two groups will be compared using student's t
test (or Mann-Whitney U test); while differences in categorical data will be compared using
the chi- square test (or Fisher's exact test). A p value of less than 0.05 will be considered