Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD

Marrara, Kamilla Tays; Lorenzo, Valéria Amorim Pires Di; Jaenisch, Rodrigo Boemo; Cabiddu, Ramona; Sato, Tatiana de Oliveira; Mendes, Renata Gonçalves; Oliveira, Cláudio Ricardo de; Costa, Dirceu; Borghi‐Silva, Audrey

doi:10.4187/respcare.05763

Cited by 14 publications

(10 citation statements)

References 41 publications

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“…However, although the NIV was initiated at rest and then titrated during exercise, in laboratory conditions and by a physiotherapist experienced in NIV, it is possible that the patients were insufficiently acclimatized to the NIV. Moreover, these negative results in patients not eligible for long-term NIV supports two recent studies performed specifically in patients with CHRF patients [29,38]. Altogether, these results suggest that, during exercise, NIV may be particularly effective in patients who are already under home NIV and tolerate higher pressure support (i.e., CHRF).…”

Section: Discussionsupporting

confidence: 73%

“…However, it was within the ranges of those used in studies that found that NIV improved endurance capacity [19,20] and matched with the level of pressure support titrated to comfort used in Anekwe et al [13]. Based on the available evidence, we included patients with severe obstruction and ventilatory limitation [7,8,38] and did not include those patients who were eligible to home NIV to prevent bias relating to experience. However, although the NIV was initiated at rest and then titrated during exercise, in laboratory conditions and by a physiotherapist experienced in NIV, it is possible that the patients were insufficiently acclimatized to the NIV.…”

Section: Discussionmentioning

confidence: 99%

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NIV Is not Adequate for High Intensity Endurance Exercise in COPD

Bonnevie

Gravier

Fresnel³

et al. 2020

JCM

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Noninvasive ventilation (NIV) during exercise has been suggested to sustain higher training intensity but the type of NIV interface, patient-ventilator asynchronies (PVA) or technological limitation of the ventilator may interfere with exercise. We assessed whether these parameters affect endurance exercise capacity in severe COPD patients. In total, 21 patients with severe COPD not eligible to home NIV performed three constant workload tests. The first test was carried out on spontaneous breathing (SB) and the following ones with NIV and a nasal or oronasal mask in a randomized order. PVA and indicators of ventilator performance were assessed through a comprehensive analysis of the flow pressure tracing raw data from the ventilator. The time limit was significantly reduced with both masks (406 s (197–666), 240 s (131–385) and 189 s (115–545), p < 0.01 for tests in SB, with oronasal and nasal mask, respectively). There were few PVA with an oronasal mask (median: 3.4% (1.7–5.2)) but the ventilator reached its maximal generating capacity (median flowmax: 208.0 L/s (189.5–224.8) while inspiratory pressure dropped throughout exercise (from 10.1 (9.4–11.4) to 8.8 cmH2O (8.6–10.8), p < 0.01). PVA were more frequent with nasal mask (median: 12.8% (3.2–31.6), p < 0.01). Particularly, the proportion of patients with ineffective efforts > 10% was significantly higher with nasal interface (0% versus 33.3%, p < 0.01). NIV did not effectively improve endurance capacity in COPD patients not acclimated to home NIV. This was due to a technological limitation of the ventilator for the oronasal mask and the consequence either of an insufficient pressure support or a technological limitation for the nasal mask.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

NIV Is not Adequate for High Intensity Endurance Exercise in COPD

Bonnevie

Gravier

Fresnel³

et al. 2020

JCM

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“…The first is to increase tolerance to exertion in severely limited patients (i.e., during or just after an ICU stay for acute exacerbation, or as a first step for a severely limited and bed-ridden patient). In this indication, NIV may allow bed-ridden subjects to walk, or perform exercises on cycloergometers, thus potentially accelerating their recovery, although this is not formally demonstrated [115, 164, 199-205]. This approach can also be provided at home for patients performing their exercises under supervision.…”

Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

et al. 2020

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Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.

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“…Also, Fujimoto et al [ 32 ] demonstrated a significant increase in 6-minute walking distance in the O 2 -trained and air-trained groups with extra benefit for oxygen on exercise tolerance because oxygen promotes exercise capacity by decreasing ventilation and respiratory rate, making breathing pattern deeper and slower with more muscle strength and endurance, also slows down the onset of diaphragmatic muscle fatigue and improves oxygen delivery leading to decrease in metabolic acidosis during exercise [ 21 ] Others as Garrod et al [ 25 ] and Spielmanns et al [ 33 ], suggested no further benefits of supplemental oxygen over room air. Nicolini et al [ 34 ], Marrara et al [ 35 ] and Borghi-Silva et al [ 17 ] agreed with the present study as they speculated clinically significant improvement in 6-minute walk distance in the NIV group as it may be interpreted by improvement in respiratory muscle strength that led to decrease in leg fatigue as NIV during training may unburden the respiratory muscles; as a result, the effect of diminished respiratory muscle blood flow is lowered, enabling most potent physiologic modification in peripheral muscles.…”

Section: Discussionmentioning

confidence: 99%

Effect of pulmonary rehabilitation programme including either O2 inhalation or noninvasive ventilation in patients with chronic obstructive pulmonary disease

Elmorshidy¹,

Elkholy²,

Elsaadany³

et al. 2023

Can J Respir Ther

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Background Pulmonary rehabilitation (PR) is crucial in managing chronic obstructive pulmonary disease (COPD) and enhancing functional capacity and health status. Oxygen therapy and noninvasive ventilation (NIV) may be needed to be incorporated into rehabilitation to augment the effectiveness of physical training. Objectives To compare and assess the impact of the PR programme alone and with augmentation with O 2 or NIV on COPD patients. Methods Seventy-five COPD patients were equally divided into three groups: group 1 patients performed 8 week-PR programme only. Group 2 performed the PR programme while receiving O 2 . Group 3 completed the PR programme plus NIV. Modified Borg scale, VO 2 max, modified Medical Research Council Dyspnea Scale, 6-minute walk test, COPD assessment test score, spirometric measures and arterial blood gases were assessed before and after the programme. Results The outcome measurements showed meaningful improvement compared with the baseline in the three studied groups. However, VO 2 max in group 3 showed higher significant improvement than both groups 1 and 2. Regarding 6-minute walk test, groups 2 and 3 had a higher significant improvement than group 1. COPD assessment test score in group 3 showed higher significant improvement than groups 1 and 2. Arterial blood gases in groups 2 and 3 showed significant increase in partial pressure of arterial oxygen and arterial oxygen saturation, but group 3 only had a significant decrease in PaCO 2 . Conclusion O 2 supplementation and NIV help severe to very severe COPD patients to perform higher exercise intensity, so they augment the benefits of PR.

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Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD

Cited by 14 publications

References 41 publications

NIV Is not Adequate for High Intensity Endurance Exercise in COPD

NIV Is not Adequate for High Intensity Endurance Exercise in COPD

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Effect of pulmonary rehabilitation programme including either O2 inhalation or noninvasive ventilation in patients with chronic obstructive pulmonary disease

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