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Kaminska M, Adam V, Orr JE. Home Noninvasive Ventilation in COPD. Chest 2024; 165:1372-1379. [PMID: 38301744 PMCID: PMC11177097 DOI: 10.1016/j.chest.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Evidence is increasing that long-term noninvasive ventilation (LTNIV) can improve outcomes in individuals with severe, hypercapnic COPD. Although the evidence remains unclear in some aspects, LTNIV seems to be able to improve patient-related and physiologic outcomes like dyspnea, FEV1 and partial pressure of carbon dioxide (Pco2) and also to reduce rehospitalizations and mortality. Efficacy generally is associated with reduction in Pco2. To achieve this, an adequate interface (mask) is essential, as are appropriate ventilation settings that target the specific respiratory physiologic features of COPD. This will ensure comfort, synchrony, and adherence that will result in physiologic improvements. This article briefly reviews the newest evidence and current guidelines on LTNIV in severe COPD. It describes an actual patient who benefitted from the therapy. Finally, it provides strategies for initiating and optimizing this LTNIV in COPD, discussing high-pressure noninvasive ventilation, optimization of triggering, and control of inspiratory time. As demand increases, clinicians will need to be familiar with this therapy to reap its benefits, because inadequately adjusted LTNIV will not be tolerated or effective.
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Affiliation(s)
- Marta Kaminska
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
| | - Veronique Adam
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, San Diego, La Jolla, CA
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Sauer J, Graßhoff J, Carbon NM, Koch WM, Weber-Carstens S, Rostalski P. Automated characterization of patient-ventilator interaction using surface electromyography. Ann Intensive Care 2024; 14:32. [PMID: 38407643 PMCID: PMC10897101 DOI: 10.1186/s13613-024-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Characterizing patient-ventilator interaction in critically ill patients is time-consuming and requires trained staff to evaluate the behavior of the ventilated patient. METHODS In this study, we recorded surface electromyography ([Formula: see text]) signals from the diaphragm and intercostal muscles and esophageal pressure ([Formula: see text]) in mechanically ventilated patients with ARDS. The sEMG recordings were preprocessed, and two different algorithms (triangle algorithm and adaptive thresholding algorithm) were used to automatically detect inspiratory patient effort. Based on the detected inspirations, major asynchronies (ineffective, auto-, and double triggers and double efforts), delayed and synchronous triggers were computationally classified. Reverse triggers were not considered in this study. Subsequently, asynchrony indices were calculated. For the validation of detected efforts, two experts manually annotated inspiratory patient activity in [Formula: see text], blinded toward each other, the [Formula: see text] signals, and the algorithmic results. We also classified patient-ventilator interaction and calculated asynchrony indices with manually detected inspirations in [Formula: see text] as a reference for automated asynchrony classification and asynchrony index calculation. RESULTS Spontaneous breathing activity was recognized in 22 out of the 36 patients included in the study. Evaluation of the accuracy of the algorithms using 3057 inspiratory efforts in [Formula: see text] demonstrated reliable detection performance for both methods. Across all datasets, we found a high sensitivity (triangle algorithm/adaptive thresholding algorithm: 0.93/0.97) and a high positive predictive value (0.94/0.89) against expert annotations in [Formula: see text]. The average delay of automatically detected inspiratory onset to the [Formula: see text] reference was [Formula: see text]79 ms/29 ms for the two algorithms. Our findings also indicate that automatic asynchrony index prediction is reliable. For both algorithms, we found the same deviation of [Formula: see text] to the [Formula: see text]-based reference. CONCLUSIONS Our study demonstrates the feasibility of automating the quantification of patient-ventilator asynchrony in critically ill patients using noninvasive sEMG. This may facilitate more frequent diagnosis of asynchrony and support improving patient-ventilator interaction.
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Affiliation(s)
- Julia Sauer
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany.
| | - Jan Graßhoff
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany
- Fraunhofer IMTE, Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - Niklas M Carbon
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - Willi M Koch
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Philipp Rostalski
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany
- Fraunhofer IMTE, Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
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McCartney A, Phillips D, James M, Chan O, Neder JA, de-Torres JP, Domnik NJ, Crinion SJ. Ventilatory neural drive in chronically hypercapnic patients with COPD: effects of sleep and nocturnal noninvasive ventilation. Eur Respir Rev 2022; 31:31/165/220069. [PMID: 36130786 DOI: 10.1183/16000617.0069-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep brings major challenges for the control of ventilation in humans, particularly the regulation of arterial carbon dioxide pressure (P aCO2 ). In patients with COPD, chronic hypercapnia is associated with increased mortality. Therefore, nocturnal high-level noninvasive positive-pressure ventilation (NIV) is recommended with the intention to reduce P aCO2 down to normocapnia. However, the long-term physiological consequences of P aCO2 "correction" on the mechanics of breathing, gas exchange efficiency and resulting symptoms (i.e. dyspnoea) remain poorly understood. Investigating the influence of sleep on the neural drive to breathe and its translation to the mechanical act of breathing is of foremost relevance to create a solid rationale for the use of nocturnal NIV. In this review, we critically discuss the mechanisms by which sleep influences ventilatory neural drive and mechanical consequences in healthy subjects and hypercapnic patients with advanced COPD. We then discuss the available literature on the effects of nocturnal NIV on ventilatory neural drive and respiratory mechanics, highlighting open avenues for further investigation.
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Affiliation(s)
| | - Devin Phillips
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Matthew James
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Olivia Chan
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Juan P de-Torres
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Nicolle J Domnik
- Dept of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Sophie J Crinion
- Dept of Medicine, Queen's University, Kingston, ON, Canada .,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
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Janssens JP, Cantero C, Pasquina P, Georges M, Rabec C. Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives. Front Med (Lausanne) 2022; 9:874523. [PMID: 35665357 PMCID: PMC9160571 DOI: 10.3389/fmed.2022.874523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Long term noninvasive ventilation (LTNIV) is a recognized treatment for chronic hypercapnic respiratory failure (CHRF). COPD, obesity-hypoventilation syndrome, neuromuscular disorders, various restrictive disorders, and patients with sleep-disordered breathing are the major groups concerned. The purpose of this narrative review is to summarize current knowledge in the field of monitoring during home ventilation. LTNIV improves symptoms related to CHRF, diurnal and nocturnal blood gases, survival, and health-related quality of life. Initially, patients with LTNIV were most often followed through elective short in-hospital stays to ensure patient comfort, correction of daytime blood gases and nocturnal oxygenation, and control of nocturnal respiratory events. Because of the widespread use of LTNIV, elective in-hospital monitoring has become logistically problematic, time consuming, and costly. LTNIV devices presently have a built-in software which records compliance, leaks, tidal volume, minute ventilation, cycles triggered and cycled by the patient and provides detailed pressure and flow curves. Although the engineering behind this information is remarkable, the quality and reliability of certain signals may vary. Interpretation of the curves provided requires a certain level of training. Coupling ventilator software with nocturnal pulse oximetry or transcutaneous capnography performed at the patient's home can however provide important information and allow adjustments of ventilator settings thus potentially avoiding hospital admissions. Strategies have been described to combine different tools for optimal detection of an inefficient ventilation. Recent devices also allow adapting certain parameters at a distance (pressure support, expiratory positive airway pressure, back-up respiratory rate), thus allowing progressive changes in these settings for increased patient comfort and tolerance, and reducing the requirement for in-hospital titration. Because we live in a connected world, analyzing large groups of patients through treatment of “big data” will probably improve our knowledge of clinical pathways of our patients, and factors associated with treatment success or failure, adherence and efficacy. This approach provides a useful add-on to randomized controlled studies and allows generating hypotheses for better management of HMV.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Hôpital de La Tour, Centre Cardio-Respiratoire, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Jean-Paul Janssens
| | - Chloé Cantero
- Service de Pneumologie, Hôpital Pitié-Salpêtrière AP-HP – Sorbonne Université, Paris, France
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marjolaine Georges
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
| | - Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
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Lalmolda C, Flórez P, Corral M, Hernández Voth A, Grimau C, Sayas J, Luján M. Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study. Int J Chron Obstruct Pulmon Dis 2022; 17:155-164. [PMID: 35058690 PMCID: PMC8765713 DOI: 10.2147/copd.s327994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The European Task Force for chronic non-invasive ventilation in stable COPD recommends the use of high pressure-support (PS) level to maximize the decrease in PaCO2. It is possible that the ventilator model can influence the need for higher or lower pressure levels. Research Question To determine the differences between ventilators in a bench model with an increased inspiratory demand; and to compare the degree of muscular unloading measured by parasternal electromyogram (EMGpara) provided by the different ventilators in real patients with stable COPD. Patients and Methods Bench: four levels of increasing progressive effort were programmed. The response of nine ventilators to four levels of PS and EPAP of 5 cm H2O was studied. The pressure-time product was determined at 300 and 500 msec (PTP 300/500). Clinical Study The ventilators were divided into two groups, based on the result of the bench test. Severe COPD patients with non-invasive ventilation (NIV) were studied, randomly comparing the performance of one ventilator from each group. Muscle unloading was measured by the decrease in EMGpara from its baseline value. Results There were significant differences in PTP 300 and PTP 500 in the bench study. Based on these results, home ventilators were classified into two groups; group 1 included four models with higher PTP 300. Ten COPD patients were recruited for the clinical study. Group 1 ventilators showed greater muscle unloading at the same PS than group 2. Conclusion The scale of pressure support in NIV for high intensity ventilation may be influenced by the ventilator model. Clinical Trials.gov NCT03373175.
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Affiliation(s)
- Cristina Lalmolda
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
| | - Pablo Flórez
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Marta Corral
- Pneumology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Carles Grimau
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Javier Sayas
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
| | - Manel Luján
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Correspondence: Manel Luján Pneumology Department, Corporació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Campus de la UAB, Plaça Cívica, Bellaterra, 08193, Barcelona, SpainTel +34937231010 Email
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Preferent Diaphragmatic Involvement in TK2 Deficiency: An Autopsy Case Study. Int J Mol Sci 2021; 22:ijms22115598. [PMID: 34070501 PMCID: PMC8199166 DOI: 10.3390/ijms22115598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Our goal was to analyze postmortem tissues of an adult patient with late-onset thymidine kinase 2 (TK2) deficiency who died of respiratory failure. Compared with control tissues, we found a low mtDNA content in the patient’s skeletal muscle, liver, kidney, small intestine, and particularly in the diaphragm, whereas heart and brain tissue showed normal mtDNA levels. mtDNA deletions were present in skeletal muscle and diaphragm. All tissues showed a low content of OXPHOS subunits, and this was especially evident in diaphragm, which also exhibited an abnormal protein profile, expression of non-muscular β-actin and loss of GAPDH and α-actin. MALDI-TOF/TOF mass spectrometry analysis demonstrated the loss of the enzyme fructose-bisphosphate aldolase, and enrichment for serum albumin in the patient’s diaphragm tissue. The TK2-deficient patient’s diaphragm showed a more profound loss of OXPHOS proteins, with lower levels of catalase, peroxiredoxin 6, cytosolic superoxide dismutase, p62 and the catalytic subunits of proteasome than diaphragms of ventilated controls. Strong overexpression of TK1 was observed in all tissues of the patient with diaphragm showing the highest levels. TK2 deficiency induces a more profound dysfunction of the diaphragm than of other tissues, which manifests as loss of OXPHOS and glycolytic proteins, sarcomeric components, antioxidants and overactivation of the TK1 salvage pathway that is not attributed to mechanical ventilation.
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Messe R, Guillien A, Claudé F, Laurent L, Degano B. [Non-invasive home ventilation in patients with severe hypercapnic chronic obstructive pulmonary disease: The SOMNOVENT' study]. Rev Mal Respir 2020; 37:756-765. [PMID: 33169687 DOI: 10.1016/j.rmr.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in cases of chronic hypercapnic respiratory failure. Following a prolonged debate, the indication and benefits of noninvasive ventilation (NIV) have been recently established. Although improved ventilation and reduction in hyperinflation appear to underlie the positive effect on NIV in COPD, only a few studies have focused on specific ventilatory algorithms for improving PaCO2. METHODS The main objective of this study is to analyze the impact of Löwenstein's ventilatory algorithms, supposed to allow a better management of hyperinflation and its consequences on alveolar ventilation and blood gas parameters. This is an interventional study in routine care, prospective, single blind, randomized with cross over. The primary endpoint will be the transcutaneous partial pressure of nocturnal carbon dioxide. Secondary endpoints will be: abnormal respiratory events occurring during nocturnal NIV; the objective quality of sleep via polysomnography; the tolerance of ventilation and the subjective quality of sleep evaluated by auto questionnaires. EXPECTED RESULTS The results of this study will clarify whether is it necessary to explore more the impact of the ventilatory modes developed by Löwenstein, dedicated to hypercapnic COPD patients, requiring a long-term NIV.
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Affiliation(s)
- R Messe
- Service de pneumologie, pôle cœur-poumon, CHRU, Besançon, France; Service de pneumologie, hôpitaux universitaires de Genève, Genève, Suisse.
| | - A Guillien
- Équipe d'épidémiologie environnementale, Institute for advanced biosciences, centre de recherche UGA, Inserm U1209, CNRS UMR, 5309, Grenoble, France
| | - F Claudé
- Service de pneumologie, pôle cœur-poumon, CHRU, Besançon, France
| | - L Laurent
- Service de pneumologie, pôle cœur-poumon, CHRU, Besançon, France
| | - B Degano
- Service hospitalier universitaire pneumologie physiologie, pôle thorax et vaisseaux, CHU Grenoble Alpes, Grenoble, France; Inserm U 1042, laboratoire HP2, université Grenoble Alpes, Grenoble, France
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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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Koch R, Augusto TRDL, Ramos AG, Müller PDT. Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial. COPD 2020; 17:384-391. [PMID: 32689839 DOI: 10.1080/15412555.2020.1789085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (T lim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4 cm H2O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30 days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved T lim (Δ = 111 s) and lower minute-ventilation (Δ = 4 L.min-1) at exhaustion, when comparing the IMT effects within the PAV modality (p = 0.001 and p = 0.036, respectively) and improved T lim for PAV vs. SHAM (PAV main-effect, p = 0.001; IMT main-effect, p = 0.006; PAV vs. IMT interaction, p = 0.034). In addition, IMT + PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p = 0.009; time main-effect, p < 0.0001; IMT vs. time interaction, p = 0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p = 0.018; time main-effect, p = 0.0001; IMT vs. time interaction, p = 0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).
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Affiliation(s)
- Rodrigo Koch
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Tiago Rodrigues de Lemos Augusto
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Alessandro Gomes Ramos
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
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Bordin DF, Cardoso DM, Wagner LE, Beckenkamp PR, Silva ALGD, Paiva DN. Sternocleidomastoid muscle activation following inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized clinical trial. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19009727022020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aims to assess the effect of short-time low frequency inspiratory muscle trainer (Threshold IMT) on inspiratory muscle strength and electromyographic activity of the sternocleidomastoid (SCM) muscle in people with chronic obstructive pulmonary disease (COPD). People with COPD participating in a lung rehabilitation program were allocated to a control or inspiratory muscle training (IMT) group. The control group participated in the usual rehabilitation, whereas the other group received IMT (performed with a load of 50% maximal inspiratory pressure (MIP) adjusted weekly). Both interventions lasted for 2 months. Outcomes included electromyographic analysis of the SCM and MIP. In total, ten participants were allocated to each group. The IMT group presented an increase in absolute (p<0.001) and predicted (p<0.001) values of MIP and also in pre- and post-intervention variation between groups (p=0.003 and p=0.008, respectively). Such differences were not found in the control group. The SCM muscle activity decreased in the IMT post intragroup evaluation (p=0.008). IMT provided a reduction of the electromyographic activity of SCM in COPD patients, also increasing inspiratory muscle strength in the study participants.
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Acute respiratory failure in randomized trials of noninvasive respiratory support: A systematic review of definitions, patient characteristics, and criteria for intubation. J Crit Care 2020; 57:141-147. [PMID: 32145657 DOI: 10.1016/j.jcrc.2020.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To examine the definitions of acute respiratory failure, the characteristics of recruited patients, and the criteria for intubation used in randomized trials. METHODS We searched MEDLINE for randomized trials of noninvasive respiratory support modalities in patients with de novo respiratory failure. We included trials from 1995 to 2017 that enrolled 40 or more patients and used intubation as an outcome. RESULTS We examined the reports of 53 trials that enrolled 7225 patients. There was wide variation in the use of variables for defining acute respiratory failure. Dyspnea was rarely measured and the increase in breathing effort was poorly defined. The characteristics of patients enrolled in trials changed over time and differed by the cause of respiratory failure. Intubation was poorly characterized. The criteria for intubation had more variables than the criteria for respiratory failure. CONCLUSIONS We identified deficiencies in the design and reporting of randomized trials, some of which can be remedied by investigators. We also found that patient characteristics differ by the type of respiratory failure. This knowledge can help clinician identify patients at the right moment to benefit from the tested interventions and investigators in developing criteria for enrollment in future trials.
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Kerl J, Höhn E, Köhler D, Dellweg D. Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia - a crossover trial. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:173-181. [PMID: 31191046 PMCID: PMC6512576 DOI: 10.2147/mder.s190841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background: There is an ongoing debate about optimal ventilator modes and settings during noninvasive ventilation (NIV). Objectives: To compare the effect of spontaneous-timed (ST) and controlled NIV on carbon dioxide reduction in patients suffering from chronic hypercapnia. Methods: Night and daytime blood gas analysis, lung function tests and 6 minute walking distance tests (6MWD) were done before and after every 6-week treatment. Results: This randomized prospective crossover trial included 42 patients. Pooled data analysis showed a decrease of nocturnal CO2 from 54.8±5.9 mmHg to 41.6±5.5 mmHg during ST ventilation (p<0.01) and from 56.2±7.5 mmHg to 42.7±5.4 mmHg during controlled NIV (p<0.01) with no difference between treatment forms (p=0.30). Daytime CO2 levels decreased from 49.3±5.5 mmHg to 45.6±4.5 mmHg when spontaneous timed ventilation was applied (p<0.01) and from 52.2±6.8 mmHg to 44.9±21114.4 mmHg in case of controlled ventilation (p<0.01) The amount of CO2 reduction was 3.8±5.6 mmHg after ST mode and 7.3±6.8 mmHg controlled ventilation (p<0.05). Nocturnal ventilator use was 5.7±2.1 and 6.7±2.3 hours for ST and controlled ventilation respectively (p=0.02). There was no effect on walking distance and lung function. Conclusion: Controlled NIV showed improved compliance compared to ST ventilation. We observed similar CO2 reductions during nocturnal ventilation, however controlled ventilation achieved a higher reduction of daytime CO2 levels.
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Affiliation(s)
- Jens Kerl
- Department for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, Germany
| | - Ekkehard Höhn
- Department for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, Germany
| | - Dieter Köhler
- Department for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, Germany
| | - Dominic Dellweg
- Department for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, Germany
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Vanfleteren LEGW, Gloeckl R. Add-on interventions during pulmonary rehabilitation. Respirology 2019; 24:899-908. [PMID: 31115114 DOI: 10.1111/resp.13585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Both pulmonary rehabilitation (PR) and chronic obstructive pulmonary disease (COPD) are generic terms and it increasingly becomes clear that rehabilitation programmes need to be tailored to the complexity and circumstances of the individual patient. Indeed, PR is described as a comprehensive, individualized intervention based on thorough assessment of identifiable treatable traits. The current review summarizes ongoing developments regarding additional interventions and tools to facilitate PR and improve outcomes in patients with a chronic respiratory disease.
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Affiliation(s)
- Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,CIRO, Horn, The Netherlands
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany
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15
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One Plus One Might not make Two: Patient-Ventilator Interaction in Non-Invasive Ventilation. Who Does What? Arch Bronconeumol 2019; 55:403-406. [PMID: 30846203 DOI: 10.1016/j.arbres.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/20/2022]
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16
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Sarlabous L, Estrada L, Cerezo-Hernández A, V. D. Leest S, Torres A, Jané R, Duiverman M, Garde A. Electromyography-Based Respiratory Onset Detection in COPD Patients on Non-Invasive Mechanical Ventilation. ENTROPY 2019; 21:e21030258. [PMID: 33266973 PMCID: PMC7514739 DOI: 10.3390/e21030258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
Abstract
To optimize long-term nocturnal non-invasive ventilation in patients with chronic obstructive pulmonary disease, surface diaphragm electromyography (EMGdi) might be helpful to detect patient-ventilator asynchrony. However, visual analysis is labor-intensive and EMGdi is heavily corrupted by electrocardiographic (ECG) activity. Therefore, we developed an automatic method to detect inspiratory onset from EMGdi envelope using fixed sample entropy (fSE) and a dynamic threshold based on kernel density estimation (KDE). Moreover, we combined fSE with adaptive filtering techniques to reduce ECG interference and improve onset detection. The performance of EMGdi envelopes extracted by applying fSE and fSE with adaptive filtering was compared to the root mean square (RMS)-based envelope provided by the EMG acquisition device. Automatic onset detection accuracy, using these three envelopes, was evaluated through the root mean square error (RMSE) between the automatic and mean visual onsets (made by two observers). The fSE-based method provided lower RMSE, which was reduced from 298 ms to 264 ms when combined with adaptive filtering, compared to 301 ms provided by the RMS-based method. The RMSE was negatively correlated with the proposed EMGdi quality indices. Following further validation, fSE with KDE, combined with adaptive filtering when dealing with low quality EMGdi, indicates promise for detecting the neural onset of respiratory drive.
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Affiliation(s)
- Leonardo Sarlabous
- Biomedical Signal Processing and Interpretation, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)—Barcelona Tech, 08028 Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
| | - Luis Estrada
- Biomedical Signal Processing and Interpretation, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)—Barcelona Tech, 08028 Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
| | - Ana Cerezo-Hernández
- Department of Pulmonology, Rio Hortega University Hospital, 47012 Valladolid, Spain
- Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
| | - Sietske V. D. Leest
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, 7500 Enschede, The Netherlands
| | - Abel Torres
- Biomedical Signal Processing and Interpretation, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)—Barcelona Tech, 08028 Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
| | - Raimon Jané
- Biomedical Signal Processing and Interpretation, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)—Barcelona Tech, 08028 Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08028 Barcelona, Spain
| | - Marieke Duiverman
- Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, 9712 Groningen, The Netherlands
| | - Ainara Garde
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics & Computer Science, University of Twente, 7500 Enschede, The Netherlands
- Correspondence: ; Tel.: +31-642-526-154
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17
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Gao E, Zhang C, Wang J. Effects of Budesonide Combined with Noninvasive Ventilation on PCT, sTREM-1, Chest Lung Compliance, Humoral Immune Function and Quality of Life in Patients with AECOPD Complicated with Type II Respiratory Failure. Open Med (Wars) 2019; 14:271-278. [PMID: 30886898 PMCID: PMC6419390 DOI: 10.1515/med-2019-0023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Our objective is to explore the effects of budesonide combined with noninvasive ventilation on procalcitonin (PCT), soluble myeloid cell triggering receptor-1 (sTREM-1), thoracic and lung compliance, humoral immune function, and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type II respiratory failure. Methods There were 82 patients with AECOPD complicated with type II respiratory failure admitted into our hospital between March, 2016-September, 2017. They were selected and randomly divided into observation group (n=41) and control group (n=41). The patients in the control group received noninvasive mechanical ventilation and the patients in the observation group received budesonide based on the control group. The treatment courses were both 10 days. Results The total effective rate in the observation group (90.25%) was higher than the control group (65.85%) (P<0.05). The scores of cough, expectoration, and dyspnea were decreased after treatment (Observation group: t=18.7498, 23.2195, 26.0043, control group: t=19.9456, 11.6261, 14.2881, P<0.05); the scores of cough, expectoration, and dyspnea in the observation group were lower than the control group after treatment (t=11.6205, 17.4139, 11.6484, P<0.05). PaO2 was increased and PaCO2 was decreased in both groups after treatment (Observation group: t=24.1385, 20.7360, control group: t=11.6606, 9.2268, P<0.05); PaO2 was higher and PaCO2 was lower in the observation group than the control group after treatment (t=10.3209, 12.0115, P<0.05). Serum PCT and sTREM-1 in both groups were decreased after treatment (Observation group: t=16.2174, 12.6698, control group: t=7.2283, 6.1634, P<0.05); serum PCT and sTREM-1 in the observation group were lower than the control group after treatment (t=10.1017, 7.8227, P<0.05). The thoracic and lung compliance in both groups were increased after treatment (Observation group: t=30.5359, 17.8471, control group: t=21.2426, 13.0007, P<0.05); the thoracic and lung compliance in the observation group were higher than the control group after treatment (t=10.8079, 5.9464, P<0.05). IgA and IgG in both groups were increased after treatment (Observation group: t=9.5794, 25.3274, control group: t=5.5000, 4.7943, P<0.05), however IgM was not statistically different after treatment (Observation group: t=0.7845, control group: t=0.1767, P>0.05); IgA and IgG in the observation group were higher than the control group (t=4.9190, 4.7943, P<0.05), however IgM was not statistically different between two groups after treatment (t=0.6168, P>0.05). COPD assessment test (CAT) scores were decreased in both groups after treatment (Observation group: t=20.6781, control group: t=9.0235, P<0.05); CAT score in the observation group was lower than the control group after treatment (t=12.9515, P<0.05). Forced expiratory volume in one second (FEV1%) and forced expiratory volume in one second/ forced expiratory volume in one second (FEV1/FVC) were increased in both groups after treatment (Observation group: t=15.3684, 15.9404, control group: t=10.6640, 12.8979, P<0.05); FEV1% and FEV1/FVC in the observation group were higher than the control group (t=6.9528, 7.3527,P<0.05). The rates of complication were not statistically different between two groups (P>0.05). Conclusion Budesonide combined with noninvasive mechanical ventilation has good curative effects in treating AECOPE patients complicated with type II respiratory failure. It can decrease serum PCT and sTREM-1, increase thoracic lung compliance, and improve the humoral immune function and life quality.
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Affiliation(s)
- Erxiang Gao
- Emergency Department, Xingyuan Hospital of Yulin, Shaanxi 719000, China
| | - Chi Zhang
- The Second Department of Internal Medicine, Xingyuan Hospital of Yulin, Shaanxi 719000, China
| | - Jianping Wang
- Department of Emergency, 1st Hospital of Yulin, Yulin City, Shaanxi Province 719000, China
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18
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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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19
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Gloeckl R, Andrianopoulos V, Stegemann A, Oversohl J, Schneeberger T, Schoenheit‐Kenn U, Hitzl W, Dreher M, Koczulla AR, Kenn K. High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial. Respirology 2018; 24:254-261. [DOI: 10.1111/resp.13399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Prevention, Rehabilitation and Sports MedicineTechnical University of Munich (TUM) Munich Germany
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Antje Stegemann
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Julian Oversohl
- Department of Internal MedicinePhilipps‐University of Marburg Marburg Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Ursula Schoenheit‐Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics)Paracelsus Medical University Salzburg Austria
- Department of Ophthalmology and OptometryParacelsus Medical University Salzburg Austria
| | - Michael Dreher
- Department of Pneumology and Intensive Care MedicineUniversity Hospital RWTH Aachen Germany
| | - A. Rembert Koczulla
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Klaus Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
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20
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Garofalo E, Bruni A, Pelaia C, Liparota L, Lombardo N, Longhini F, Navalesi P. Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation. Expert Rev Respir Med 2018; 12:557-567. [DOI: 10.1080/17476348.2018.1480941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luisa Liparota
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Nicola Lombardo
- Otolaryngology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care, Sant’Andrea Hospital, Vercelli, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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21
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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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22
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Storre JH, Callegari J, Magnet FS, Schwarz SB, Duiverman ML, Wijkstra PJ, Windisch W. Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease: patient selection and perspectives. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535515 PMCID: PMC5836655 DOI: 10.2147/copd.s154718] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine basis. In particular, there is ongoing debate about Home-NIV in chronic hypercapnic COPD regarding the overall effects, the most favorable treatment strategy, the selection of eligible patients, and the time point at which it is prescribed. The current review focuses on specific aspects of patient selection and discusses the various scientific as well as clinical-guided perspectives on Home-NIV in patients suffering from chronic hypercapnic COPD. In addition, special attention will be given to the topic of ventilator settings and interfaces.
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Affiliation(s)
- Jan Hendrik Storre
- Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Jens Callegari
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Friederike Sophie Magnet
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - 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
| | - 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
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
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23
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Lopez-Campos JL, Caballero-Eraso C, Barrot-Cortés E. Home mechanical ventilation for stable COPD in GOLD 2017: What are we ventilating? Respirology 2017; 22:1497-1499. [PMID: 28560720 DOI: 10.1111/resp.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/06/2017] [Accepted: 05/07/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Jose L Lopez-Campos
- Medical-Surgical Unit of Respiratory Diseases, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/University of Seville, Seville, Spain.,Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Candelaria Caballero-Eraso
- Medical-Surgical Unit of Respiratory Diseases, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/University of Seville, Seville, Spain
| | - Emilia Barrot-Cortés
- Medical-Surgical Unit of Respiratory Diseases, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/University of Seville, Seville, Spain.,Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), Institute of Health Carlos III, Madrid, Spain
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24
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Abstract
Home noninvasive ventilation (NIV) is used in COPD patients with concomitant chronic hypercapnic respiratory failure in order to correct nocturnal hypoventilation and improve sleep quality, quality of life, and survival. Monitoring of home NIV is needed to assess the effectiveness of ventilation and adherence to therapy, resolve potential adverse effects, reinforce patient knowledge, provide maintenance of the equipment, and readjust the ventilator settings according to the changing condition of the patient. Clinical monitoring is very informative. Anamnesis focuses on the improvement of nocturnal hypoventilation symptoms, sleep quality, and side effects of NIV. Side effects are major cause of intolerance. Screening side effects leads to modification of interface, gas humidification, or ventilator settings. Home care providers maintain ventilator and interface and educate patients for correct use. However, patient's education should be supervised by specialized clinicians. Blood gas measurement shows a significant decrease in PaCO2 when NIV is efficient. Analysis of ventilator data is very useful to assess daily use, unintentional leaks, upper airway obstruction, and patient ventilator synchrony. Nocturnal oximetry and capnography are additional monitoring tools to assess the impact of NIV on gas exchanges. In the near future, telemonitoring will reinforce and change the organization of home NIV for COPD patients.
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Affiliation(s)
- Jean-Michel Arnal
- a Réanimation Polyvalente , Hôpital Sainte Musse , Toulon Cedex , France
| | - Joëlle Texereau
- b VitalAire France , Air Liquide HealthCare , Gentilly , France.,c AP-HP, Respiratory Physiology Department , Cochin Hospital, René Descartes University , Paris , France
| | - Aude Garnero
- c AP-HP, Respiratory Physiology Department , Cochin Hospital, René Descartes University , Paris , France
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