NIV Is not Adequate for High Intensity Endurance Exercise in COPD
Open Access
- 7 April 2020
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 9 (4), 1054
- https://doi.org/10.3390/jcm9041054
Abstract
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.This publication has 56 references indexed in Scilit:
- High- and low-level pressure support during walking in people with severe kyphoscoliosisEuropean Respiratory Journal, 2010
- Clinical relevance of constant power exercise duration changes in COPDEuropean Respiratory Journal, 2009
- Respiratory muscle unloading improves leg muscle oxygenation during exercise in patients with COPDThorax, 2008
- Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPDThorax, 2008
- Training with inspiratory pressure support in patients with severe COPDEuropean Respiratory Journal, 2006
- VENTILATORY SUPPORT DURING TRAINING IMPROVES TRAINING BENEFIT IN SEVERE CHRONIC AIRWAY OBSTRUCTIONJournal of Cardiopulmonary Rehabilitation, 2005
- Noninvasive Ventilation During Exercise Training Improves Exercise Tolerance in Patients With Chronic Obstructive Pulmonary DiseaseJournal of Cardiopulmonary Rehabilitation, 2003
- Effects of Training With Heliox and Noninvasive Positive Pressure Ventilation on Exercise Ability in Patients With Severe COPDSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2002
- The Acute Effects of Noninvasive Ventilatory Support During Exercise on Exercise Endurance and Dyspnea in Patients With Chronic Obstructive Pulmonary DiseaseJournal of Cardiopulmonary Rehabilitation, 2002
- Lack of additional effect of adjunct of assisted ventilation to pulmonary rehabilitation in mild COPD patients.Respiratory Medicine, 2002