Normocapnia during nIPPV in chronic hypercapnic COPD reduces subsequent spontaneous PaCO2

Windisch, Wolfram; Vogel, Michael; Sorichter, Stephan; Hennings, E.; Bremer, Hinrich; Hamm, H; Matthys, H; Virchow, Jr Jc

doi:10.1053/rmed.2002.1326

Cited by 88 publications

(63 citation statements)

References 26 publications

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“…1) Patients were ventilated with relatively high inspiratory pressures (20 cmH 2 O). While these are lower than the pressures used by WINDISCH et al [15], they are higher than the pressures used in the older randomised controlled trials [16]. This might explain why the study by DUIVERMAN et al [14] found a significantly improved gas exchange that was not the reported in the older studies.…”

Section: Nocturnal Ventilatory Support In Addition To Exercise Trainingmentioning

confidence: 79%

New tools in pulmonary rehabilitation

Wijkstra¹,

Wempe²

2011

Eur Respir J

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In patients with more severe chronic obstructive pulmonary disease (COPD), the benefits of rehabilitation might not be clear and, therefore, new treatment options have been developed to increase the benefits of rehabilitation. This review provides an overview of new approaches being developed as an addition to exercise training. In turn, the benefits of adding ventilatory support, oxygen, anabolics or neuromuscular stimulation to a rehabilitation programme will be discussed. While positive benefits for a number of these approaches have been found, many questions remain unsolved. Therefore, at present, we cannot recommend these new tools as part of the routine management of patients with COPD who start a rehabilitation programme.KEYWORDS: Anabolics, neuromuscular stimulation, oxygen, rehabilitation, ventilatory support C urrent literature has shown that pulmonary rehabilitation is effective in patients with chronic obstructive pulmonary disease (COPD) by improving dyspnoea, exercise tolerance and quality of life [1][2][3]. However, in patients with more severe COPD the benefits of rehabilitation might be less; therefore, new treatment options have been developed to increase rehabilitation results. In this review, we will provide an overview of the new approaches to pulmonary rehabilitation that are an addition to exercise training. VENTILATORY SUPPORT DURING EXERCISE OR EXERCISE TRAININGAdvanced COPD is generally characterised by severe airflow limitation, which is frequently associated with hyperinflation. This will especially worsen during exercise when the absence of any flow reserve requires the subject to breath at a higher lung volume to adjust to the increased ventilatory requirements. The work of breathing will be increased, primarily to overcome the intrinsic positive end-expiratory pressures. As during exercise, the increased ventilatory requirements are difficult to sustain, new approaches are needed to assist patients with the mechanical output during exercise. During recent decades, a number of studies have investigated this topic by applying different types of ventilator support during exercise. In 1990, PETROF et al.[4] demonstrated that continuous positive airway pressure (CPAP) reduced inspiratory muscle effort, as indicated by the pressure-time integral of transdiaphragmatic and oesophageal pressure. In addition, they found that dyspnoea improved with CPAP in five out of the eight patients and that the amelioration of dyspnoea was directly related to reductions in the pressure-time integral of the oesophageal pressure. O'DONNELL et al. [5] showed that by applying 4-5 cmH 2 O of CPAP to patients with COPD (mean forced expiratory volume in 1 s (FEV1) 1.2 L), less breathlessness was experienced during steady-state submaximal exercise. In addition, they showed that similar levels of CPAP administered to patients with even more severe COPD (mean FEV1 0.9 L) improved the patient's endurance capacity during constant power cycle exercise by 48% [6]. A study comparing inspiratory pressure suppo...

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Section: Nocturnal Ventilatory Support In Addition To Exercise Trainingmentioning

confidence: 79%

New tools in pulmonary rehabilitation

Wijkstra¹,

Wempe²

2011

Eur Respir J

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“…70 This technique has been described as high-intensity NIV. 71,72 Both physiological and clinical studies have further shown that improvements in blood gases, lung function, and breathing pattern are achievable with high-intensity NIV.…”

Section: High-intensity Niv In Copdmentioning

confidence: 99%

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

et al. 2015

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During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous European experts took part in this session and discussed (1) NIV in amyotrophic lateral sclerosis (when to start NIV, NIV and sleep, secretion management, and what to do when NIV fails), (2) recent insights in NIV and COPD (high-intensity NIV, NIV in addition to exercise training, and NIV during exercise training), (3) monitoring of NIV (monitoring devices, built-in ventilator software, leaks, and asynchronies) and identifying events during NIV; and (4) recent and future developments in NIV (target-volume NIV, electromyography-triggered NIV, and autoregulating algorithms)

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“…All of these and most other studies used a moderately aggressive ventilation to treat stable hypercapnic COPD patients and so an impressive reduction in hypercapnia was not achieved. In contrast, more aggressive form of ventilation with mean IPAP of up to 30 cmH20 or even higher was used in recent studies by Windish et al and a remarkable reduction of PC02 was achieved (Windisch et al 2002;Windisch et al 2005;Windisch et al 2006). Another RCT also has shown an improvement in survival with the application of nocturnal NPPV in end stage chronic hypercapnic COPD.…”

Section: Severe Stable Copd/chronic Respiratory Failure In Patients Wmentioning

confidence: 99%

Noninvasive Positive-Pressure Ventilation Therapy in Patients with COPD

Uçar¹

2012

Chronic Obstructive Pulmonary Disease - Current Concepts and Practice

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Normocapnia during nIPPV in chronic hypercapnic COPD reduces subsequent spontaneous PaCO2

Cited by 88 publications

References 26 publications

New tools in pulmonary rehabilitation

New tools in pulmonary rehabilitation

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

Noninvasive Positive-Pressure Ventilation Therapy in Patients with COPD

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