Effects of bi-level positive airway pressure on ventilatory and perceptual responses to exercise in comorbid heart failure-COPD

The Significance of Implementing Bilevel Positive Airway Pressure under Cluster Nursing in Improving the Survival Possibility of Patients with Severe Pulmonary Infection Complicated by Respiratory Failure

Objective. To explore the significance of bilevel positive airway pressure (BIPAP) under cluster nursing in improving the survival probability of patients with severe pulmonary infection (SPI) complicated by respiratory failure (RF). Methods. This research included 153 SPI patients complicated by RF ( $\text{SPI}+\text{RF}$ ) admitted between January 2020 and March 2022, including 55 cases in group A who were treated with BIPAP under cluster care during hospitalization, 47 cases in group B receiving invasive continuous mechanical ventilation during hospitalization, and 51 cases in group C treated with BIPAP under routine care during hospitalization. The three cohorts were compared regarding pre- and posttreatment serum inflammatory factors (IFs), blood gas (BG) parameters, heart rate (HR), and respiratory rate (RR). Besides, the cumulative time of ventilator use, successful ventilator weaning rate, mortality, and incidence of adverse events were counted. Finally, patients were scored for their psychological state using the Hamilton Anxiety/Depression Scale (HAMA/HAMD). Results. The posttreatment TNF-α, IL-6, PCT, WBC, and PaCO2 reduced statistically in all the three groups, with the lowest levels found in group A and the highest in group B ( $P<0.05$ ); while PaO2 and SpO2 increased, with the highest values found in group A and the lowest in group B ( $P<0.05$ ). Among the three groups, group A had the shortest duration of ventilator use, the highest successful weaning rate, and the lowest incidence of adverse events ( $P<0.05$ ). Besides, HAMA and HAMD scores were the lowest in group A among the three groups, while those in group B were higher compared with group C ( $P<0.05$ ). Conclusion. The implementation of BIPAP under cluster nursing can effectively reduce inflammatory responses of $\text{SPI}+\text{RF}$ patients, improve their vital signs, and enhance their psychological state, which has extremely high clinical application value.

Heart, lungs, and muscle interplay in worsening activity-related breathlessness in advanced cardiopulmonary disease

PURPOSE OF REVIEW

Activity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD).

RECENT FINDINGS

The drive to breathe increases ('excessive breathing') secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung-chest wall displacement because of the mechanical derangements brought by COPD ('inappropriate breathing'). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction.

SUMMARY

Beyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure-COPD.