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Schneeberger T, Jarosch I, Leitl D, Gloeckl R, Hitzl W, Dennis CJ, Geyer T, Criée CP, Koczulla AR, Kenn K. Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial. Thorax 2023; 78:326-334. [PMID: 34656996 PMCID: PMC10086462 DOI: 10.1136/thoraxjnl-2020-216509] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 09/05/2021] [Indexed: 11/04/2022]
Abstract
RATIONALE In patients with COPD, oxygen (O2)-supplementation via a constant flow oxygen system (CFOS) can result in insufficient oxygen saturation (SpO2 <90%) during exercise. An automatically titrating O2-system (ATOS) has been shown to be beneficial compared with an untitrated CFOS, however, it is unknown if ATOS is superior to CFOS, titrated during exercise as stipulated by guidelines. The aim was to investigate the effects of ATOS compared with titrated CFOS on walking capacity in people with hypoxaemic COPD. METHODS Fifty participants completed this prospective randomised controlled, double-blind, crossover trial. Participants performed two endurance shuttle walk tests (ESWTs) with: (1) exercise titrated CFOS (ESWTCFOS) and (2) ATOS targeting an SpO2 of 92% (ESWTATOS). Primary outcome measure was walking time. Secondary measures were SpO2, transcutaneous-PCO2 (TcPCO2), respiratory rate (RR), heart rate (HR) at isotime (end of shortest ESWT) with blood gases and dyspnoea at rest and end exercise. RESULTS Participants (median (IQR): age 66 (59, 70) years, FEV1 28.8 (24.8, 35.1) % predicted, PO2 54.7 (51.0, 57.7) mm Hg, PCO2 44.2 (38.2, 47.8) mm Hg) walked significantly longer with ESWTATOS in comparison to ESWTCFOS (median effect (95% CI) +144.5 (54 to 241.5) s, p<0.001). At isotime, SpO2 was significantly higher (+3 (95% CI 1 to 4) %, p<0.001) with ATOS while TcPCO2, RR and HR were comparable. End exercise, PO2 (+8.85 (95% CI 6.35 to 11.9) mm Hg) and dyspnoea (-0.5 (95% CI -1.0 to -0.5) points) differed significantly in favour of ATOS (each p<0.001) while PCO2 was comparable. CONCLUSION In patients with hypoxaemia with severe COPD the use of ATOS leads to significant, clinically relevant improvements in walking endurance time, SpO2, PO2 and dyspnoea with no impact on PCO2. TRIAL REGISTRATION NUMBER NCT03803384.
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Affiliation(s)
- Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany .,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Leitl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Clancy John Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tatjana Geyer
- Medical School, Philipps-University of Marburg, Marburg, Hessen, Germany
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Goettingen-Weende, Bovenden, Germany
| | - Andreas Rembert Koczulla
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center, Giessen, Hessen, Germany.,Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Klaus Kenn
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Hessen, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center, Giessen, Hessen, Germany
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Chao KY, Liu WL, Nassef Y, Tseng CW, Wang JS. Effects of high-flow nasal cannula with oxygen on self-paced exercise performance in COPD: A randomized cross-over trial. Medicine (Baltimore) 2021; 100:e28032. [PMID: 34941043 PMCID: PMC8701785 DOI: 10.1097/md.0000000000028032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Studies have demonstrated that noninvasive ventilation improves exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The role of heated humidified high-flow nasal cannula (HFNC) therapy in patients with COPD on self-paced exercise performance remains unclear. Therefore, the purpose of the present study was to determine whether HFNC-aided supplemental oxygen during a 6-minute walk test (6MWT) would change self-paced exercise performance and cardiopulmonary outcomes in patients with stable COPD. METHODS A single-site, cross-over trial was conducted in a pulmonary rehabilitation outpatient department. This study enrolled 30 stable COPD patients without disability. The participants with and without HFNC performed 6MWTs on 2 consecutive days. Outcomes were the distance walked in the 6MWT, physiological, and cardiopulmonary parameters. RESULTS Those performing HFNC-aided walking exhibited a longer walking distance than those performing unaided walking. The mean difference in meters walked between the HFNC-aided and unaided walking scenarios was 27.3 ± 35.6 m (95% CI: 14.4-40.5 m). The energy expenditure index was significantly lower when walking was aided by HHHNFC rather than unaided (median: 1.21 beats/m walked vs median: 1.37 beats/m walked, P < .001). However, there were no differences in transcutaneous carbon dioxide tension between HHHNFC and non-HHHNFC patients. CONCLUSION Walking distance and arterial oxygen saturation improved in stable COPD patients receiving HFNC with additional oxygen support. However, HFNC did not affect transcutaneous carbon dioxide tension and the self-reported dyspnea score during the walking test. The present study demonstrated the feasibility and safety of using HFNC in self-paced exercise. TRIAL REGISTRATION NCT03863821.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Lun Liu
- Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yasser Nassef
- Institution of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jong-Shyan Wang
- Heart Failure Center, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical Collage, Chang Gung University, Tao-Yuan, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
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Tomasic I, Tomasic N, Trobec R, Krpan M, Kelava T. Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput 2018; 56:547-569. [PMID: 29504070 PMCID: PMC5857273 DOI: 10.1007/s11517-018-1798-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/30/2018] [Indexed: 01/03/2023]
Abstract
Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.
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Affiliation(s)
- Ivan Tomasic
- Division of Intelligent Future Technologies, Mälardalen University, Högskoleplan 1, 72123, Västerås, Sweden.
| | - Nikica Tomasic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Trobec
- Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Miroslav Krpan
- Department of Cardiology, University Hospital Centre, Zagreb, Croatia
| | - Tomislav Kelava
- Department of Physiology, School of Medicine, University of Zagreb, Zagreb, Croatia
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Malloy C, Dayaram V, Martha S, Alvarez B, Chukwudolue I, Dabbain N, Mahmood DD, Goleva S, Hickey T, Ho A, King M, Kington P, Mattingly M, Potter S, Simpson L, Spence A, Uradu H, Van Doorn J, Weineck K, Cooper RL. The effects of potassium and muscle homogenate on proprioceptive responses in crayfish and crab. JOURNAL OF EXPERIMENTAL ZOOLOGY PART 2017; 327:366-379. [PMID: 29356422 DOI: 10.1002/jez.2096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022]
Abstract
Proprioception of limbs and joints is a basic sensory function throughout most of the animal kingdom. It is important to understand how proprioceptive organs and the associated sensory neurons function with altered environments such as increased potassium ion concentrations ([K+]) from diseased states, ionic imbalances, and damaged tissues. These factors can drastically alter neuronal activity. To assess this matter, we used the chordotonal organ in a walking leg of a blue crab (Callinectes sapidus) and the muscle receptor organ of the crayfish (Procambarus clarkii). These organs serve as tractable models for the analysis of proprioception. The preparations can help serve as translational models for these effects, which may be observed in other invertebrate species as well as mammalian species (including humans). When extracellular potassium concentration ([K+]o) is increased to 20 mM in both preparations, mixed results are observed with activity increasing in some preparations and decreasing in others after mechanical displacement. However, when [K+]o is increased to 40 mM, activity drastically decreases in all preparations. Additionally, proprioceptor sensory activity declines upon exposure to a diluted muscle homogenate, which contains a host of intracellular constituents. The robust effects of altered [K+] on proprioception in these models illuminate the potential detriments on neuronal function in cases of severe tissue damage as well as altered [K+]o.
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Affiliation(s)
- Cole Malloy
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Viresh Dayaram
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Sarah Martha
- Department of Biology, University of Kentucky, Lexington, Kentucky.,College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Brenda Alvarez
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | | | - Nadera Dabbain
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Dlovan D Mahmood
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Slavina Goleva
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Tori Hickey
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Angel Ho
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Molly King
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Paige Kington
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | | | - Samuel Potter
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Landon Simpson
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Amanda Spence
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Henry Uradu
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Jacob Van Doorn
- Department of Biology, University of Kentucky, Lexington, Kentucky
| | - Kristin Weineck
- Department of Medicine, Rostock University, Rostock, MV, Germany
| | - Robin L Cooper
- Department of Biology, University of Kentucky, Lexington, Kentucky
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