Impact of Nocturnal Noninvasive Ventilation on Pulmonary Rehabilitation in Patients with End-Stage Lung Disease Awaiting Lung Transplantation

Kneidinger, Nikolaus; Gloeckl, Rainer; Schönheit-Kenn, U; Milger, Katrin; Hitzl, Wolfgang; Behr, Jürgen; Kenn, Klaus

doi:10.1159/000484056

Cited by 14 publications

(10 citation statements)

References 30 publications

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“…Pulmonary rehabilitation (PR) including exercise training is a cornerstone modality of chronic obstructive pulmonary disease (COPD) management with a level ‘A’ evidence to improve exercise capacity, dyspnoea and quality of life . Promising evidences have shown that COPD patients with chronic hypercapnic respiratory failure (CHRF) may benefit from PR . However, their severely impaired clinical status and reduced capacity may restrain them in performing conventional exercise training including cycle endurance exercise.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Promising evidences have shown that COPD patients with chronic hypercapnic respiratory failure (CHRF) may benefit from PR. 3,4 However, their severely impaired clinical status and reduced capacity may restrain them in performing conventional exercise training including cycle endurance exercise. A number of studies have investigated the effects of noninvasive ventilation (NIV) as a supplemental tool during exercise with the goal of enabling exercise training at higher intensities not usually feasible for these patients.…”

Section: Introductionmentioning

confidence: 99%

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High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

et al. 2018

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Background and objective Patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnic respiratory failure (CHRF) characteristically have exercise intolerance and limitations in performing conventional training. Therefore, the aim of this study was to investigate the acute effects of non‐invasive ventilation (NIV) as a supportive tool during exercise in CHRF. Methods Two cycle endurance tests (CET) at 60% of the peak work rate were performed. Patients were randomly assigned to cycle in two conditions: (i) high‐pressure NIV (mean inspiratory positive airway pressure: 27 ± 3 cm H2O) along with oxygen supplementation or (ii) control: oxygen‐use only. Transcutaneously measured partial pressure of carbon dioxide (TcPCO2), oxygen saturation and heart rate were continuously recorded. Muscle oxygen availability of intercostal and vastus lateralis muscle was measured during exercise by near‐infrared spectroscopy (NIRS). Results A total of 20 patients with CHRF (forced expiratory volume in 1 s (FEV1): 19 ± 4% predicted, partial pressure of oxygen (PaO2): 55 ± 9 mm Hg, partial pressure of carbon dioxide (PaCO2): 51 ± 7 mm Hg) were recruited in a randomized cross‐over trial. On NIV, COPD patients increased cycle endurance time by 39% compared to oxygen‐use only (663 ± 360 vs 477 ± 249 s, P = 0.013). On NIV, TcPCO2 was significantly lower at rest (44.9 ± 6.2 vs 50.7 ± 6.6 mm Hg, P < 0.001) and at isotime (50.0 ± 5.5 vs 56.1 ± 6.2 mm Hg, P < 0.001). Oxygen availability in the intercostal muscles remained relatively constant with NIV compared to oxygen‐use only. Although patients cycled longer using NIV, a lower increase in exertional dyspnoea at the end of CET (median increase in Borg‐dyspnoea: 2 vs 4, P = 0.003) was reported. Conclusion NIV with high pressures as add‐on to oxygen supplementation increases cycle endurance time, mitigates exertional dyspnoea and limits exercise‐induced hypercapnia in COPD patients with CHRF.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

et al. 2018

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“…Indeed, NIV is not expected to be beneficial in patients with kyphoscoliosis. During a specialised inpatient PR study, 296 of 1044 patients awaiting lung transplantation received nocturnal NIV due to hypercapnia 40. The increase in 6MWD after PR in the NIV group was higher, although by only 11 m. LTOT and NIV are potentially valuable therapeutic options, in particular to support patients with COPD with severe lung hyperinflation and exercise-induced oxygen desaturation41 in the context of exercise training as part of a comprehensive PR programme.…”

Section: Exercise Training Combined With Oxygen Supplementation or Nomentioning

confidence: 99%

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

Spruit

Rochester

Pitta

et al. 2019

Thorax

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“…Furthermore, despite more severe disease, patients under NIV had a greater benefit from rehabilitation than patients without NIV [31]. …”

Section: Exercise Training For Patients With Cvfmentioning

confidence: 99%

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

Vitacca

Ambrosino

2018

Respiration

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Background: Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients’ symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. Objective: This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. Methods: We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords “chronic respiratory failure AND exercise,” “non invasive ventilation AND exercise,” “pulmonary rehabilitation” and “exercise training.” Results: Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. Conclusion: We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.

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Impact of Nocturnal Noninvasive Ventilation on Pulmonary Rehabilitation in Patients with End-Stage Lung Disease Awaiting Lung Transplantation

Cited by 14 publications

References 30 publications

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

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