1
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Lu S, Zhang Q. Pilot testing the impact of an aerobic exercise plus rehabilitation training on respiratory function in older adults with COPD. Geriatr Nurs 2023; 51:238-244. [PMID: 37023683 DOI: 10.1016/j.gerinurse.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic intractable lung disease. To investigate the therapeutic effect, older adult patients were subjected to aerobic exercise and respiratory rehabilitation (diaphragmatic breathing) for six months. At the end of six-month intervention, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), 6-minute walking distance (6 MWD), and patient activation measure scores increased; St. George's respiratory questionnaire scores and disease impact score decreased; and PaCO2 and PaO2 were significantly improved in both groups, particularly in the experimental group. In addition, FEV1, FEV1/FVC, 6 MWD, blood gas levels, quality of life, and self-care ability in the experimental group were significantly improved compared with those in the control group, and the improvements were significantly greater in male, younger, and less diseased patients. Our study demonstrated that aerobic exercise combined with diaphragmatic breathing significantly improves respiratory function and quality of life in older adult patients.
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Affiliation(s)
- Shuangping Lu
- Department of Respiratory Medicine, The First People's Hospital of Fuyang District, Hangzhou, China
| | - Qundan Zhang
- Department of Respiratory Medicine, The First People's Hospital of Fuyang District, Hangzhou, China.
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2
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Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support? Sleep Breath 2022; 27:673-677. [DOI: 10.1007/s11325-022-02658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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3
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
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4
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Nasal high flow therapy in heart failure patients with central sleep apnea: a report of disproportional occurrence of cardiac arrhythmias. Sleep Med 2021; 79:119-121. [PMID: 33524836 DOI: 10.1016/j.sleep.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/30/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
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5
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Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
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6
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"Tricks and tips for home mechanical ventilation" Home mechanical ventilation: set-up and monitoring protocols. Pulmonology 2020; 27:144-150. [PMID: 32912752 DOI: 10.1016/j.pulmoe.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022] Open
Abstract
In this part of the review series "Tricks and tips for home mechanical ventilation", we will discuss the evidence with regard to the place and manner of home mechanical ventilation initiation and follow-up. Outsourcing more and more of this chronic care to the home situation is a big challenge for the future: especially for the home situation, monitoring has to be non-invasive, reliable and easy to use, data security needs to be ensured, signals need to be integrated and preferably automatically processed and algorithms need to be developed based on clinically relevant outcomes.
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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8
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van der Leest S, Duiverman ML. High-intensity non-invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice. Respirology 2018; 24:318-328. [PMID: 30500099 DOI: 10.1111/resp.13450] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 01/12/2023]
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) frequently develop chronic hypercapnic respiratory failure (CHRF), with disabling symptoms and poor survival. The use of long-term nocturnal non-invasive ventilation (NIV) to treat CHRF in COPD has long been subject of debate due to conflicting evidence. However, since the introduction of high-intensity NIV (HI-NIV) in COPD, physiological and clinical benefits have been shown. HI-NIV refers to specific ventilator settings used for NIV aimed at achieving normocapnia or the lowest partial arterial carbon dioxide pressure (PaCO2 ) values as possible. This review will provide an overview of existing evidence of the efficacy of HI-NIV stable COPD patients with CHRF. Secondly, we will discuss hypotheses underlying NIV benefit in stable hypercapnic COPD, providing insight into better patient selection and hopefully more individually titrated HI-NIV. Finally, we will provide practical advice on how to initiate and follow-up patients on HI-NIV, with special emphasis on monitoring that should be available during the initiation and follow-up of HI-NIV, and will discuss more extended monitoring techniques that could improve HI-NIV treatment in the future.
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Affiliation(s)
- Sietske van der Leest
- Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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9
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Yazar EE, Özlü T, Sarıaydın M, Taylan M, Ekici A, Aydın D, Coşgun İG, Durmuş Koçak N. Prospective cross-sectional multicenter study on domiciliary noninvasive ventilation in stable hypercapnic COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2367-2374. [PMID: 30127600 PMCID: PMC6089109 DOI: 10.2147/copd.s164384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Domiciliary noninvasive ventilation (NIV) use in stable hypercarbic COPD is becoming increasingly widespread. However, treatment compliance criteria and factors related to compliance remain to be defined. Methods This research was designed as a prospective, cross-sectional, multicenter real-life study. Chronic hypercapnic COPD patients who were using domiciliary NIV for at least 1 year and being followed up in 19 centers across Turkey were included in the study. The patients who used NIV regularly, night or daytime and ≥5 hours/d, were classified as “high-compliance group,” and patients who used NIV irregularly and <5 hours/d as “low-compliance group.” Results Two hundred and sixty-six patients with a mean age of 64.5±10.3 years were enrolled, of whom 75.2% were males. They were using domiciliary NIV for 2.8±2 years. Spontaneous time mode (p<0.001) and night use (p<0.001) were more frequent in the high-compliance group (n=163). Also, mean inspiratory positive airway pressure values of the high-compliance group were significantly higher than the low-compliance group (n=103; p<0.001). Cardiac failure (p=0.049) and obesity (p=0.01) were significantly more frequent in the high-compliance group. There were no difference between 2 groups regarding hospitalization, emergency department and intensive care unit admissions within the last year, as well as modified Medical Research Council dyspnea and COPD Assessment Test scores. With regard to NIV-related side effects, only conjunctivitis was observed more frequently in the high-compliance group (p=0.002). Conclusion Determination of the patients who have better compliance to domiciliary NIV in COPD may increase the success and effectiveness of treatment. This highly comprehensive study on this topic possesses importance as it suggests that patient and ventilator characteristics may be related to treatment compliance.
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Affiliation(s)
- Esra Ertan Yazar
- Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey,
| | - Tevfik Özlü
- Department of Pulmonology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Muzaffer Sarıaydın
- Department of Pulmonology, School of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Mahşuk Taylan
- Department of Pulmonology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Aydanur Ekici
- Department of Pulmonology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Derya Aydın
- Department of Pulmonology, Balıkesir Chest Disease Government Hospital, Balıkesir, Turkey
| | - İbrahim Güven Coşgun
- Department of Pulmonology, Afyonkarahisar Government Hospital, Afyonkarahisar, Turkey
| | - Nagihan Durmuş Koçak
- Department of Pulmonology, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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10
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Skytioti M, Søvik S, Elstad M. Respiratory pump maintains cardiac stroke volume during hypovolemia in young, healthy volunteers. J Appl Physiol (1985) 2018; 124:1319-1325. [DOI: 10.1152/japplphysiol.01009.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Spontaneous breathing has beneficial effects on the circulation, since negative intrathoracic pressure enhances venous return and increases cardiac stroke volume. We quantified the contribution of the respiratory pump to preserve stroke volume during hypovolemia in awake, young, healthy subjects. Noninvasive stroke volume, cardiac output, heart rate, and mean arterial pressure (Finometer) were recorded in 31 volunteers (19 women), 19–30 yr old, during normovolemia and hypovolemia (approximating 450- to 500-ml reduction in central blood volume) induced by lower-body negative pressure. Control-mode noninvasive positive-pressure ventilation was employed to reduce the effect of the respiratory pump. The ventilator settings were matched to each subject’s spontaneous respiratory pattern. Stroke volume estimates during positive-pressure ventilation and spontaneous breathing were compared with Wilcoxon matched-pairs signed-rank test. Values are overall medians. During normovolemia, positive-pressure ventilation did not affect stroke volume or cardiac output. Hypovolemia resulted in an 18% decrease in stroke volume and a 9% decrease in cardiac output ( P < 0.001). Employing positive-pressure ventilation during hypovolemia decreased stroke volume further by 8% ( P < 0.001). Overall, hypovolemia and positive-pressure ventilation resulted in a reduction of 26% in stroke volume ( P < 0.001) and 13% in cardiac output ( P < 0.001) compared with baseline. Compared with the situation with control-mode positive-pressure ventilation, spontaneous breathing attenuated the reduction in stroke volume induced by moderate hypovolemia by 30% (i.e., −26 vs. −18%). In the patient who is critically ill with hypovolemia or uncontrolled hemorrhage, spontaneous breathing may contribute to hemodynamic stability, whereas controlled positive-pressure ventilation may result in circulatory decompensation. NEW & NOTEWORTHY Maintaining spontaneous respiration has beneficial effects on hemodynamic compensation, which is clinically relevant for patients in intensive care. We have quantified the contribution of the respiratory pump to cardiac stroke volume and cardiac output in healthy volunteers during normovolemia and central hypovolemia. The positive hemodynamic effect of the respiratory pump was abolished by noninvasive, low-level positive-pressure ventilation. Compared with control-mode positive-pressure ventilation, spontaneous negative-pressure ventilation attenuated the fall in stroke volume by 30%.
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Affiliation(s)
- Maria Skytioti
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Signe Søvik
- Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maja Elstad
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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11
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Duiverman ML. Noninvasive ventilation in stable hypercapnic COPD: what is the evidence? ERJ Open Res 2018; 4:00012-2018. [PMID: 29637078 PMCID: PMC5890025 DOI: 10.1183/23120541.00012-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 12/21/2022] Open
Abstract
Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.
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Affiliation(s)
- Marieke L. Duiverman
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, Groningen, The Netherlands
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12
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Zhou L, Guan L, Wu W, Li X, Chen X, Guo B, Huo Y, Xu J, Yang Y, Chen R. High-pressure versus low-pressure home non-invasive positive pressure ventilation with built-in software in patients with stable hypercapnic COPD: a pilot study. Sci Rep 2017; 7:16728. [PMID: 29196698 PMCID: PMC5711850 DOI: 10.1038/s41598-017-17142-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/22/2017] [Indexed: 11/09/2022] Open
Abstract
High-pressure non-invasive positive pressure ventilation (NPPV) is a new strategy targeted at maximally reducing arterial carbon dioxide. However, high inspiratory positive airway pressure (IPAP) might cause respiratory adverse events likely to diminish the benefit of NPPV. In the setting of ventilatory support, monitoring NPPV efficacy and resolving problems promptly are critical. This study assessed the treatment effect of high and low-pressure NPPV in chronic hypercapnic COPD using home ventilator with built-in software. In this pilot study, we investigated 34 patients using NPPV for 3 months. 13 patients used high-pressure ventilation and 21 patients used low-pressure ventilation. The primary outcome was daytime partial pressure of arterial blood carbon dioxide (PaCO2). There were no between-group differences in daytime PaCO2 and FEV1, but a trend favouring high-pressure NPPV was observed. Significant between-group differences were found in the transition dyspnoea index (TDI) (high-pressure, 1.69 ± 1.75, versus low-pressure, -0.04 ± 2.71, p = 0.044). No differences were found in usage time, leakage, health-related quality of life, spirometry, or 6-minute walk test. High-pressure NPPV with built-in software monitoring in patients with chronic hypercapnic COPD is associated with improvement in TDI scores and a positive trend in favour of high-pressure NPPV for improving PaCO2 is observed.
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Affiliation(s)
- Luqian Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lili Guan
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiliang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Li
- The First Affiliated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xin Chen
- ZhuJiang Hospital of Southern Medical University, Guangzhou, China
| | - Bingpeng Guo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yating Huo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiawen Xu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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13
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Schwarz SB, Magnet FS, Windisch W. Why High-Intensity NPPV is Favourable to Low-Intensity NPPV: Clinical and Physiological Reasons. COPD 2017; 14:389-395. [DOI: 10.1080/15412555.2017.1318843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. B. Schwarz
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
| | - F. S. Magnet
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
| | - W. Windisch
- Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Germany
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14
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Duiverman ML, Maagh P, Magnet FS, Schmoor C, Arellano-Maric MP, Meissner A, Storre JH, Wijkstra PJ, Windisch W, Callegari J. Impact of High-Intensity-NIV on the heart in stable COPD: a randomised cross-over pilot study. Respir Res 2017; 18:76. [PMID: 28464911 PMCID: PMC5414301 DOI: 10.1186/s12931-017-0542-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients. METHODS In a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated. RESULTS Three patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life. CONCLUSIONS Long-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output. TRIAL REGISTRATION The trial was registered in the Deutsches Register Klinischer Studien (DRKS-ID: DRKS00007977 ).
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Affiliation(s)
- Marieke Leontine Duiverman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands. .,Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany.
| | - Petra Maagh
- Department of Cardiology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
| | - Friederike Sophie Magnet
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Maria Paola Arellano-Maric
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany.,Department of Pulmonary Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Axel Meissner
- Department of Cardiology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
| | - Jan Hendrik Storre
- Asklepios Fachkliniken Munich-Gauting, Gauting, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Peter Jan Wijkstra
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
| | - Jens Callegari
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
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