Non‐invasive ventilation during arm exercise and ground walking in patients with chronic hypercapnic respiratory failure

This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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“…Isotime comparisons are also responsive outcomes of interventions directed to train arm muscles [134][135][136].…”

Section: Evaluativementioning

confidence: 99%

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

et al. 2016

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“…As many chest wall muscles that are involved in the performance of upper-limb activities also et al [32] similarly found a small but signifi cant improvement in Sp,O 2 at rest and at isotime exercise with NIV plus supplemental oxygen compared with supplemental oxygen alone during ground walking. However, despite the improvement in gas exchange, exercise capacity was not improved.…”

Section: Upper-limb Exercisementioning

confidence: 81%

“…POGGI et al [31] demonstrated that arm elevation signifi cantly increased inspiratory muscle work in COPD patients with chronic respiratory failure and that NIV during arm elevation reduced dynamic intrinsic positive end expiratory pressure (PEEPi) and inspiratory muscle work while increasing minute ventilation. In a heterogeneous group of patients with chronic hypercapnic respiratory failure enrolled in an acute randomised crossover trial, NIV during unsupported arm exercise increased endurance time, reduced dyspnoea and perceived exertion and improved oxygenation compared with exercise without NIV [32]. In this study, supplemental oxygen was added during exercise testing to maintain arterial oxygen saturation measured by pulse oximetry (Sp,O 2 ) at ~93% at rest.…”

Section: Lower-limb Exercisementioning

confidence: 99%

“…While NIV can acutely improve exercise performance and provide additional benefi ts during a lower-limb exercise training programme in selected patients, there is limited data on the feasibility of using NIV during functional activities such as ground walking [32][33][34]. In a randomized trial DREHER et al [33] found that plus NIV and oxygen signifi cantly improved arterial oxygen tension (Pa,O 2 ), increased distance walked and reduced dyspnoea compared with walking with oxygen alone in patients with severe stable COPD already established on home NIV.…”

Section: Niv During Functional Activitiesmentioning

confidence: 99%

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Noninvasive ventilation as an adjunct to exercise training in patients with chronic respiratory disease

Piper

Menadue

2009

breathe

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Educational aimsTo describe the potential benefits of noninvasive positive-pressure ventilation (NIV) as an adjunct to exercise training in selected patients with chronic obstructive pulmonary disease (COPD) or chest wall restriction.To outline the mechanisms by which NIV may improve exercise performance in selected patients with COPD or chest wall restriction.To identify characteristics of patients with chronic respiratory disease who are more likely to respond to NIV-assisted training.To highlight major practical considerations for implementing NIV-assisted training in an individual with COPD or chest wall restriction.SummarySevere exertional dyspnoea is a major impediment to physical activity and adversely affects quality of life for many individuals with chronic respiratory disease. Although exercise can improve cardiorespiratory and peripheral muscle responses, training at sufficient intensity and duration may be difficult for the very breathless, deconditioned patient. Consequently, strategies to optimise training for such individuals are gaining interest. NIV is one such option and there is a growing body of evidence outlining its benefits in selected patients. However, the technique is not without its constraints and problems. An understanding of the mechanisms underlying improvements in exercise performance with NIV-assisted training is important in targeting appropriate candidates for intervention and identifying the best therapy to achieve the maximum benefit.

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“…Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking, resulting in improved oxygenation, decreased dyspnoea and increased walking distance. Therefore, NIV during walking could prevent hypoxia-induced complications [120,121]. Nocturnal NIV has been suggested as an addition to diurnal pulmonary rehabilitation in COPD patients [122,123].…”

Section: Rehabilitationmentioning

confidence: 99%

Unusual applications of noninvasive ventilation

Ambrosino¹,

Guarracino²

2011

Eur Respir J

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The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice. Herein, we review the use of NIV in unusual conditions.Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful after surgery, including cardiac surgery, and, with a lower level of evidence, in patients with pulmonary contusion.NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea. The role of assisted ventilation during exercise training in chronic obstructive pulmonary disease patients is still controversial.NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV.

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Non‐invasive ventilation during arm exercise and ground walking in patients with chronic hypercapnic respiratory failure

Cited by 26 publications

References 28 publications

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Noninvasive ventilation as an adjunct to exercise training in patients with chronic respiratory disease

Unusual applications of noninvasive ventilation

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