Efficiency of neural respiratory drive for the assessment of bronchodilator responsiveness in patients with chronic obstructive pulmonary disease: an exploratory study

Li, Yun; Li, Yinhuan; Li, Shuo; Luo, Yuqi; Xiao, Rui; Huang, Yuxia; Huang, Jin-Lun; YiTai, Chen; Zhi, Rong-Chang; Chen, Xin

doi:10.21037/jtd.2016.03.70

Cited by 8 publications

(3 citation statements)

References 25 publications

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“… 26 In this way, Reilly et al demonstrated in cystic fibrosis patients how neural drive, measured by EMGpara, decrease to a great extent (−39%) after an infectious exacerbation resolves. 12 In a similar way, neural drive measured by EMGpara has been proposed as a tool to evaluate the effectiveness of bronchodilators 27 or even as marker of hyperinflation. In this latter topic, neural respiratory drive may reflect mechanics impairment in COPD patients, mainly related to expiratory flow limitation and hyperinflation.…”

Section: Discussionmentioning

confidence: 99%

Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

Lalmolda

Flórez

Corral

et al. 2022

COPD

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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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Section: Discussionmentioning

confidence: 99%

Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

Lalmolda

Flórez

Corral

et al. 2022

COPD

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“…These indices could be also of potential value to evaluate therapeutic interventions, such as inhaled bronchodilators, noninvasive ventilation, or inspiratory muscle training, aimed at reducing intrinsic respiratory mechanical loading in COPD patients [36]. Indeed, the efficiency of NRD, defined as the ratio of minute ventilation to the root mean square of invasive oesEMG di measures, has been demonstrated to be a sensitive index to evaluate the response to inhaled bronchodilators in COPD, with significant improvements reported after bronchodilation [37]. The application of the noninvasive indices proposed in this study in evaluating treatment benefits could therefore be a subject of future research.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Assessment of Neuromechanical and Neuroventilatory Coupling in COPD

Lozano-García

Estrada-Petrocelli

Blanco-Almazan

et al. 2022

IEEE J. Biomed. Health Inform.

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This study explored the use of parasternal second intercostal space and lower intercostal space surface electromyogram (sEMG) and surface mechanomyogram (sMMG) recordings (sEMG para and sMMG para , and sEMG lic and sMMG lic , respectively) to assess neural respiratory drive (NRD), neuromechanical (NMC) and neuroventilatory (NVC) coupling, and mechanical efficiency (MEff) noninvasively in healthy subjects and chronic obstructive pulmonary disease (COPD) patients. sEMG para , sMMG para , sEMG lic , sMMG lic , mouth pressure (P mo ), and volume (V i ) were measured at rest, and during an inspiratory loading protocol, in 16 COPD patients (8 moderate and 8 severe) and 9 healthy subjects. Myographic signals were analyzed using fixed sample entropy and normalized to their largest values (fSEsEMG para%max , fSEsMMG para%max , fSEs-EMG lic%max , and fSEsMMG lic%max ). fSEsMMG para%max , fSEsEMG para%max , and fSEsEMG lic%max were significantly higher in COPD than in healthy participants at rest. Parasternal intercostal muscle NMC was significantly higher in healthy than in COPD participants at rest, but not during threshold loading. P mo -derived NMC and MEff ratios were lower in severe patients than in mild patients or healthy subjects during threshold loading, but differences were not consistently significant. During resting breathing and threshold loading, V i -derived NVC and MEff ratios were significantly lower in severe patients than in mild patients or healthy subjects. sMMG is a potential noninvasive alternative to sEMG for assessing NRD in COPD. The ratios of P mo and V i to sMMG and sEMG measurements provide wholly noninvasive NMC, NVC, and MEff indices that are sensitive to impaired respiratory mechanics in COPD and are therefore of potential value to assess disease severity in clinical practice.

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“…The change in the neural respiratory drive (NRD) has been used to evaluate the efficacy of several drugs (16,17), and to predict the risk of acute exacerbation of COPD (18). Noninvasive positive pressure ventilation (NPPV) is to overcome airway resistance and improve ventilation, thereby reduce the work of breathing and the burden on the respiratory muscle, and facilitate sufficient rest of fatigued respiratory muscle (19,20).…”

Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study

Wang¹,

Liang²,

Wang³

et al. 2020

J Thorac Dis

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Background: Continuous positive airway pressure (CPAP) is a major treatment strategy for severe chronic obstructive pulmonary disease (COPD), especially with respiratory failure. However, it remains inconclusive whether CPAP affects respiratory mechanics and neural drive in stable COPD patients without respiratory failure. Methods: Twenty-two COPD patients without respiratory failure received CPAP starting from 4 to 10 cmH 2 O in 1 cmH 2 O increments. Respiratory pattern, end expiatory lung volume (EELV), dynamic PEEPi (PEEPi dyn ), airway resistance (Raw), pressure-time product of diaphragmatic pressure (PTPdi) and esophageal pressure (PTPeso), root mean square (RMS) of diaphragm electromyogram (EMGdi) and ratio of ventilation (Ve) to EMGdi (i.e., Ve/RMS) were measured before and at each level of continue positive airway pressure (CPAP). A subgroup analysis was performed between patients with and without inspiratory muscle weakness. Results: Nineteen patients completed the treatment. The respiratory pattern improved significantly after CPAP. Raw, PTPdi, and Pdi decreased significantly. ΔEELV decreased at 4 cmH 2 O (P<0.05), but increased significantly at >8 cmH 2 O. PEEPi dyn decreased from 2.18±0.98 to 1.37±0.55 cmH 2 O. RMS increased while Ve/RMS improved significantly after CPAP (P<0.05). Besides, CPAP could significantly improve respiratory mechanics in patients with inspiratory muscle weakness. Conclusions: CPAP improves respiratory pattern, PEEPi, Raw, work of breathing and efficiency of neural drive in COPD patients without respiratory failure, but easily increases dynamic pulmonary hyperinflation.These effects on respiratory mechanics are significant in patients with inspiratory muscle weakness.

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Efficiency of neural respiratory drive for the assessment of bronchodilator responsiveness in patients with chronic obstructive pulmonary disease: an exploratory study

Cited by 8 publications

References 25 publications

Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

Noninvasive Assessment of Neuromechanical and Neuroventilatory Coupling in COPD

Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study

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