Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure

Schönhofer, Bernd; Barchfeld, T.; Wenzel, M; Köhler, Dieter

doi:10.1136/thorax.56.7.524

Cited by 60 publications

(28 citation statements)

References 16 publications

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“…It may be of interest to monitor the KCO of patients after a period of nocturnal ventilation to assess whether changes in KCO follow the improvements in arterial O 2 and CO 2 . This is supported by a recent study by SCHÖ NHOFER et al [23], who reported that effective long-term noninvasive mechanical ventilation in patients with restrictive lung disease reduces pulmonary artery pressure. To the current authors9 knowledge, there are no other studies of KCO and VA in chronic neuromuscular disease, although a strong relationship exists between the reduction in VA and the increase in KCO in patients with scoliosis [24].…”

Section: Significance Of the Findingssupporting

confidence: 60%

Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes

Hart¹,

Cramer²,

Ward³

et al. 2002

Eur Respir J

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In clinical practice, an elevated carbon monoxide (CO) transfer coefficient (KCO) and restrictive ventilatory defect are taken as features of respiratory muscle weakness (RMW). However, the authors hypothesised that both pattern and severity of RMW effect gas transfer and lung volumes.Measurements of CO transfer and lung volumes were performed in patients with isolated diaphragm weakness (n=10), inspiratory muscle weakness (n=12), combined inspiratory and expiratory muscle weakness (n=5) and healthy controls (n=6).Patients with diaphragm weakness and inspiratory muscle weakness had reduced total lung capacity (TLC) (83.6% predicted and 68.9% pred, respectively), functional residual capacity (FRC) (83.9% pred and 83.6% pred) and transfer factor of the lung for CO (TL,CO) (86.2% pred and 66.2% pred) with increased KCO (114.1% pred and 130.2% pred). Patients with combined inspiratory and expiratory muscle weakness had reduced TLC (80.9% pred) but increased FRC (109.9% pred) and RV (157.4% pred) with decreased TL,CO (58.0% pred) and KCO (85.5% pred).In patients with diaphragm weakness, the increase in carbon monoxide transfer coefficient was similar to that of normal subjects when alveolar volume was reduced. However, the increase in carbon monoxide transfer coefficient in inspiratory muscle weakness was often less than expected, while in combined inspiratory and expiratory muscle weakness, the carbon monoxide transfer coefficient was normal/reduced despite further reductions in alveolar volume, which may indicate subtle abnormalities of the lung parenchyma or pulmonary vasculature. Thus, this study demonstrates the limitations of using carbon monoxide transfer coefficient in the diagnosis of respiratory muscle weakness, particularly if no account is taken of the alveolar volume at which the carbon monoxide transfer coefficient is made. Transfer factor of the lung for carbon monoxide (CO) (TL,CO) is the product of the CO transfer coefficient (KCO), which indicates the rate constant of CO uptake from the alveoli and the alveolar volume (VA) at which the measurement is made [1]. Many studies, including the original study by KROGH [1], have shown that if CO transfer is measured at submaximal VA, the decline in TL,CO is partially offset by an increase in KCO. In clinical practice, CO uptake is measured at total lung capacity (TLC), but many disease states associated with a reduced TLC often have coexistent intrapulmonary disease and, as a consequence, have a reduction in KCO. However, when the cause of the reduced TLC is extrapulmonary, a distinctive pattern may be found in which KCO is increased at full inflation and VA is decreased, so that reductions in TL,CO are smaller than observed in intrapulmonary disease. The most obvious disorder simulating the effects of submaximal inflation is inspiratory muscle weakness without intrapulmonary disease. In an influential study of six patients [2], in which TLC was reduced due to severe isolated diaphragm weakness, a relatively benign disease in the absence of other...

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Section: Significance Of the Findingssupporting

confidence: 60%

Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes

Hart¹,

Cramer²,

Ward³

et al. 2002

Eur Respir J

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“…CRF = c h r o n i c r e s p i r a t o r y f a i l u r e . monary resistance during vasodilator therapy in patients with primary pulmonary hypertension (16). In patients with RTD, long-term NPPV therapy reportedly improved pulmonary hemodynamics (30,31 (15,16) and that it is a strong prognostic marker in patients with chronic heart failure (14,15), primary pulmonary hypertension (16), and Eisenmenger syndrome (18 (2,9). In this study, 52% of patients (15 of 29) were taking loop diuretics, and 24% of patients (7 of 29) …”

Section: ) In Addition Paco2 Decreased Significantly After Nppvmentioning

confidence: 95%

Significance of Serum Uric Acid in Patients with Chronic Respiratory Failure Treated with Non-invasive Positive Pressure Ventilation

et al. 2007

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“…Endurance time increased by 278¡269% during an inspiratory threshold loading test, by 176¡159% during a cycle ergometer test, and by 32¡22% during a shuttle walking test. Pulmonary haemodynamics have also been shown to improve significantly after 1 yr of NPPV in patients with chest wall deformity [29].…”

Section: Contraindicationsmentioning

confidence: 99%

Noninvasive ventilation for chest wall and neuromuscular disorders

Shneerson¹,

Simonds²

2002

Eur Respir J

164

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Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis).If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative.There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that “prophylactic” ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease.There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is ∼90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.

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Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure

Cited by 60 publications

References 16 publications

Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes

Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes

Significance of Serum Uric Acid in Patients with Chronic Respiratory Failure Treated with Non-invasive Positive Pressure Ventilation

Noninvasive ventilation for chest wall and neuromuscular disorders

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