Volume-assured pressure support versus bilevel positive airway pressure in non-invasive ventilation: A systematic review of clinical effectiveness

IF 2.1 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2026-05-01 DOI:10.1016/j.resinv.2026.101441

Narat Srivali , Federica De Giacomi

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Abstract

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.

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无创通气中容量保证压力支持与双水平气道正压：临床效果的系统评价

容量保证压力支持（VAPS）模式自动调节吸气压力以维持目标通气，理论上改进了传统的双水平气道正压（BiPAP）。然而，它们在不同临床背景下的比较有效性仍然不完全确定。方法系统回顾MEDLINE、EMBASE和Cochrane数据库至2025年5月，比较VAPS和BiPAP。由于不同的CO2动力学，研究根据临床环境（急性与慢性/稳定）先验分层。主要终点：血气参数，特别是PaCO2)。次要终点包括临床成功率、患者舒适度、依从性和死亡率。结果共分析了15项研究（763名受试者）。在急性情况下，VAPS在两项研究中显示出更快的PaCO2纠正（0.18 kPa/h加快，p < 0.001； 83.3% vs 30分钟正常化66.6%,p = 0.015）；其中四个表现出相同的反应。在高碳酸血症衰竭中，插管率倾向于VAPS (6.4% vs 15.2%)，但一项研究（n = 89）表明低氧血症衰竭有潜在危害（60% vs 42%, p > 0.05）。在慢性环境中，两种模式都达到了相同的气体交换（七项研究中的六项）。患者依从性比模式选择更能预测生存率（HR 0.34, 95% CI: 0.18-0.64）。这些产生假设的发现表明，VAPS在急性高碳酸血症性呼吸衰竭中提供更快的早期稳定，在慢性稳定状态下提供相同的结果。然而，地层内的大量异质性限制了颗粒指导，特别是在慢性环境中合并机械不同的疾病（慢性阻塞性肺疾病、肥胖低通气综合征、神经肌肉疾病）。低氧血症失败的插管差异（单一研究，n = 89）需要重复。在确定建议之前，需要进行针对特定疾病的随机试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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