MONDAY,SEPTEMBER 3 RD 2012 243. Advanced experience with long-term noninvasive ventilation and late-breaking abstracts P2062 A randomised controlled trial comparing stepwise versus immediate withdrawal from non-invasive ventilation in chronic obstructive pulmonary disease patients recovering from acute hypercapnic respiratory failure Chung Tat Lun , Chung Ming Chu, Veronica Lee Chan, Wah Shing Leung, Pik Shan Cheung, Suet Lai Cheng, Miranda Tsui. Department of Medicine, The United Christian Hospital, Kwun Tong, Hong Kong, Hong Kong Background: COPD patients who suffer from exacerbation with acute hypercap- nic respiratory failure (AHcRF) benefit from non-invasive ventilation (NIV). The best withdrawal method of NIV is not known. Aim and objectives: To compare the success rate of withdrawal in NIV between stepwise withdrawal and immediate withdrawal in COPD patients with AHcRF. Method: This was a prospective, single-centre, open-labelled randomised study comparing stepwise and immediate withdrawal of NIV. The primary end-point was the success rate of NIV withdrawal. The secondary end-points were hospital length of stay and duration of NIV use. Results: Sixty patients were randomised: 35 patients to the stepwise withdrawal group and 25 patients to the immediate withdrawal group. There was no statisti- cally significant difference in the success rate of withdrawal of NIV and length of stay after randomisation, with the success rate of 74.3% and 56% in stepwise and immediate withdrawal group respectively (p = 0.139). There was statistically significant difference in the duration of NIV with median duration of 5 days and 3 days in stepwise and immediate withdrawal group respectively (p = 0.001). The post-hoc analysis showed the use of LAMA, higher inhaled steroid dosage and higher arterial pH value on randomisation were the factors associated with success in withdrawal in the immediate group. Conclusion: Our study showed no significant difference in the success rate and length of stay between stepwise withdrawal and immediate withdrawal of NIV. Duration of NIV was significantly shorter in the immediate withdrawal group. P2063 Automatic tailoring of positive end-expiratory pressure (PEEP) by forced oscillation technique (FOT) during non-invasive ventilation: Effects of posture and exertion in COPD Raffaele Dellaca 1 , Bob Romano 2 , Joe Garuccio 3 , Cherian John 3 , Ramesh Thimmiah 3 , Melvin Saludes 3 , Charles Cain 2 . 1 Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy; 2 Home Respiratory Care, Philips Respironics, Monroeville, PA, United States; 3 Cardio-Pulmonary Medicine, Regional Medical Associates, Burgettstown, PA, United States Expiratory Flow Limitation (EFL) promotes the development of intrinsic PEEP (PEEPi). EFL can be detected by FOT at 5 Hz from the difference between inspi- ratory and expiratory reactance (Xrs) during quiet breathing (ERJ 2004;23:232) and CPAP (ERJ 2006;27: 983). This non-invasive measurement has been incorpo- rated in a mechanical ventilator (Synchrony, Philips/Respironics, USA) resulting in a prototype that continuously measures Xrs and automatically adjusts PEEP to the minimum pressure able to abolish EFL (PEEPopt). The aim of this study was to measure PEEPopt in a group of COPD patients and to evaluate its alterations with changes in posture and during a six minute walking test (6MWT). Eleven COPD patients (GOLD stage 2-4, BMI 30±10, FEV1%pred 48±12, Figure 1 FEV1/FVC 56±8) were initiated to nasal BiPAP with automatic PEEP adjustment. After adaptation, ventilation was applied for 10 minutes in the seated and supine positions and during a 6MWT. Data were recorded in the last minute for each condition. At PEEP=2cmH2O, 8 patients showed EFL in the seated position, 10 in the supine and 9 in the last minute of the 6MWT. The average PEEPopt is reported in figure. In mild to severe COPD, the development of EFL is greatly affected by posture and exertion and this results in major adjustments in the PEEP required to counteract PEEPi within the same patient. P2064 Impact of intelligent volume assured pressure support on sleep quality, compliance and gas exchange in patients with stable hypercapnic COPD Emelie Ekkernkamp 1 , David Walker 1 , Jan Hendrik Storre 2 , Wolfram Windisch 2 , Michael Dreher 1 . 1 Department of Pneumology, University Hospital, Freiburg, Germany; 2 Department of Pneumology, Clinic of Cologne, Germany Introduction: Noninvasive positive pressure ventilation (NPPV) using the tech- nique of high-intensity-NPPV (HI-NPPV) has been shown to treat hypoventilation in stable hypercapnic COPD patients with an overall good sleep quality (SQ). iVAPS (intelligent volume assured pressure support) using target alveolar ventila- tion is a hybrid mode of NPPV. Its impact on SQ still needs to be addressed. The aim of the study was to compare SQ and gas exchange using iVAPS and HI-NPPV in hospital and at home. Methods: In a randomized crossover design patients used iVAPS and HI-NPPV. Objective and subjective SQ as well as comfort with NPPV were assessed by polysomnography and questionnaires. Blood gas measurements were performed in hospital and at home (Figure 1). Figure 1 Results: 14 patients were included. Beside applied pressure being rated more disturbing with iVAPS, there was no further difference with regard to SQ in hospital. At home, patients reported more restful sleep using iVAPS. There was no difference in daily usage (6.2±1.6 vs. 6.5±1.3h, p=0.27). PaCO2 in hospital was lower during iVAPS (41±8mmHg vs. 44±7 mmHg; p=0.04), whereas no difference was found at home (43±7 vs. 44±10mmHg; p=0.37). Conclusion: NPPV using iVAPS and HI-NPPV revealed no differences in SQ in hospital. At home, patients reported more restful sleep during iVAPS without differences in comfort with NPPV and daily usage. P2065 How to assess sensorium in hypercapnic encephalopathy during NIV? Raffaele Scala , Uberto Maccari, Carmen Manta, Claudia Maggiorelli, Irene Di Pierro. Respiratory Ward and RIICU, S. Donato Hospital, Arezzo, Israel Aims: To compare the clinical usefulness of two different tools, Glasgow Coma Scale (GCS) and Kelly-Matthay score (KMS), for the neurological assessment of hypercapnic encephalopathy (HE) during NIV. Methods: We prospectively analysed 101 consecutive patients [age, mean (DS), 76.6 (8.41) yrs; COPD 61.4%; CWD 22.8%; CHF 9.9%; Neuromuscular disorders 5.9%) with HE [GCS, median (IQR 25-75), 9 (6-11); KMS 4 (3-5)] due to acute respiratory failure [(pH 7.23 (0.08); PaO 2 /FiO 2 174 (64), PaCO 2 87.6 (20.3) mmHg] submitted to NIV in our RIICU in the yrs 2008-2010. Primary end-point: Capability of earlier GCS/KMS changes (2-hours) to predict NIV failure; Secondary end-points: 1) sensitivity of GCS/KMS to the earlier (2-hours) and later (24-hours) changes of arterial blood gases (ABG) under NIV; 2) pulmonary and extra-pulmonary determinants of GCS/KMS at baseline. Results: Earlier changes in KMS (>20%) predicted NIV failure (p=0.026) while this is not the case for GCS. Earlier changes in pH and PaCO 2 were significantly correlated with those in KMS (p<0.01) but not with those in GCS, while later changes in ABG significantly correlated with those in both scores (p<0.0001). According to a multivariate analysis, both GCS and KMS showed a signifi- cant association with pulmonary (baseline pH) and extra-pulmonary determinants 364s Thematic Poster Session Halle A-5 - 12:50 - 14:40 Abstract printing supported by . Visit Chiesi at Stand B2.10