Non-Invasive Haemodynamic Effects of Two Nasal Positive Pressure Ventilation Modalities in Stable Chronic Obstructive Lung Disease Patients

Marangoni, S.; Vitacca, Michele; Quadri, A; Schena, Miriam; Clini, Enrico

doi:10.1159/000196658

Cited by 17 publications

(12 citation statements)

References 23 publications

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“…Our noninvasively obtained haemodynamic findings are consistent with previous observations made by MARANGONI et al [27] and AMBROSINO et al [28]. In both of these studies, cardiac output was reduced during NPPV, especially when PEEP was also applied.…”

Section: Discussionsupporting

confidence: 93%

Physiological changes during low- and high-intensity noninvasive ventilation

Lukácsovits¹,

Carlucci²,

Hill³

et al. 2011

Eur Respir J

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In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation.One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO 2 ) (highintensity ( We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease.

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Section: Discussionsupporting

confidence: 93%

Physiological changes during low- and high-intensity noninvasive ventilation

Lukácsovits¹,

Carlucci²,

Hill³

et al. 2011

Eur Respir J

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“…PEEP, even at rest, might be associated with the complex effects on hemodynamics in COPD Marangoni et al 1997;Díaz et al 1997;Confalonieri et al 1998;Kong et al 2001). During exercise, IPS ?…”

Section: Introductionmentioning

confidence: 99%

Influence of respiratory pressure support on hemodynamics and exercise tolerance in patients with COPD

et al. 2010

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Inspiratory pressure support (IPS) plus positive end-expiratory pressure (PEEP) ventilation might potentially interfere with the "central" hemodynamic adjustments to exercise in patients with chronic obstructive pulmonary disease (COPD). Twenty-one non- or mildly-hypoxemic males (FEV(1) = 40.1 +/- 10.7% predicted) were randomly assigned to IPS (16 cmH(2)O) + PEEP (5 cmH(2)O) or spontaneous ventilation during constant-work rate (70-80% peak) exercise tests to the limit of tolerance (T (lim)). Heart rate (HR), stroke volume (SV), and cardiac output (CO) were monitored by transthoracic cardioimpedance (Physioflow, Manatec, France). Oxyhemoglobin saturation was assessed by pulse oximetry (SpO(2)). At similar SpO(2), IPS(16) + PEEP(5) was associated with heterogeneous cardiovascular effects compared with the control trial. Therefore, 11 patients (Group A) showed stable or increased Delta "isotime" - rest SV [5 (0-29) mL], lower DeltaHR but similar DeltaCO. On the other hand, DeltaSV [-10 (-15 to -3) mL] and DeltaHR were both lower with IPS(16) + PEEP(5) in Group B (N = 10), thereby reducing DeltaCO (p < 0.05). Group B showed higher resting lung volumes, and T (lim) improved with IPS(16) + PEEP(5) only in Group A [51 (-60 to 486) vs. 115 (-210 to 909) s, respectively; p < 0.05]. We conclude that IPS(16) + PEEP(5) may improve SV and exercise tolerance in selected patients with advanced COPD. Impaired SV and CO responses, associated with a lack of enhancement in exercise capacity, were found in a sub-group of patients who were particularly hyperinflated at rest.

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“…The majority of studies were rated high on methodological quality. [17,20,[25][26][27][28][29][30]. However, heterogeneity was evident (p50.13).…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Within non-RCTs, those which used lower bilevel pressures [26,27] showed less Pa,CO 2 reduction than those that reported greater Pa,CO 2 reduction with higher pressure levels [17,20,25,28,29]. Improvements in ventilatory parameters and reduction of PEEPi,dyn reported in one study [17] were proportional to the bilevel NIPPV pressures applied.…”

Section: Respiratory Functionmentioning

confidence: 99%

Systematic review of noninvasive positive pressure ventilation in severe stable COPD

Kolodziej¹,

Jensen²,

Rowe³

et al. 2007

Eur Respir J

137

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The present systematic review examined the effectiveness of bilevel noninvasive positive pressure ventilation (NIPPV) in the management of chronic respiratory failure (CRF) due to severe stable chronic obstructive pulmonary disease (COPD).Randomised controlled trials (RCTs) and non-RCTs (crossover design) of adults with severe stable COPD and CRF receiving bilevel NIPPV via nasal, oronasal or total face mask were identified from electronic databases and manual screening of journals and reference lists.Respiratory function (gas exchange, lung function, ventilatory/breathing pattern, respiratory muscle function and work of breathing) and health-related outcomes (dyspnoea, functional status, exercise tolerance, health-related quality of life (HRQOL), morbidity and mortality) were assessed.In total, 15 studies met the inclusion criteria: six RCTs and nine non-RCTs. RCTs did not find improved gas exchange with bilevel NIPPV, while non-RCTs did. Lung hyperinflation and diaphragmatic work of breathing were reduced in a nonrandomised subset. HRQOL and dyspnoea, the least studied outcomes, showed improvement with bilevel NIPPV.In a subset of individuals on maximal medical treatment regimes for severe stable chronic obstructive pulmonary disease, bilevel noninvasive positive pressure ventilation may have an adjunctive role in the management of chronic respiratory failure through attenuation of compromised respiratory function and improvement in health-related outcomes.KEYWORDS: Chronic obstructive pulmonary disease, chronic respiratory failure, noninvasive positive pressure ventilation, systematic review C hronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD) contributes a significant social and economic burden to individuals, families and the healthcare system. The incidence of COPD, in terms of its combined mortality and disability, was the 12th highest for diseases worldwide in 1990 and is expected to become the fifth highest by 2020, with mortality expected to increase fivefold by 2015 [1][2][3]. The rate of progression, the extent of airflow obstruction and airway hyperreactivity, and the impairment in alveolar ventilation and gas exchange contribute to the heterogeneity of COPD and the extent of chronic bronchitic versus emphysematous change that occurs. Reduced alveolar ventilation in CRF due to COPD results in nocturnal and daytime gas exchange abnormalities, sleep-disordered breathing, dyspnoea and increased work of breathing, which in turn lead to significant functional impairment, morbidity and mortality [4]. The eventual development of CRF is characterised by varying degrees of ventilation-perfusion mismatch, hypoxia and hypercapnia [5]. Reduced respiratory reserve associated with ongoing morbidity renders COPD patients at risk of acute respiratory decompensation [6,7]. Symptom management and prevention of respiratory decompensation are important in reducing morbidity and mortality associated with COPD.The use of bilevel noninvasive positive pressure ventilation (NIPPV)...

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Non-Invasive Haemodynamic Effects of Two Nasal Positive Pressure Ventilation Modalities in Stable Chronic Obstructive Lung Disease Patients

Cited by 17 publications

References 23 publications

Physiological changes during low- and high-intensity noninvasive ventilation

Physiological changes during low- and high-intensity noninvasive ventilation

Influence of respiratory pressure support on hemodynamics and exercise tolerance in patients with COPD

Systematic review of noninvasive positive pressure ventilation in severe stable COPD

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