IntroductionSleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system.Case presentationWe report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment.ConclusionsUse of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.
[Purpose] We aimed to determine the effects of ventilation feedback using electrical
stimulation on ventilation pattern during exercise in patients with chronic obstructive
pulmonary disease (COPD), and develop new rehabilitation methods. [Subjects] This
randomized double-blind placebo-controlled trial included 24 patients with COPD. [Methods]
Phasic electrical stimulation during expiration (PESE) or a placebo was given to all the
cases. Minute ventilation (VE), tidal volume (TV), respiratory rate (RR), expiratory time
(Te), total respiratory time (Ttot), dead-space gas volume to tidal gas volume (VD/VT),
oxygen uptake (VO2), carbon dioxide output (VCO2), Borg scale
(Borg), and percutaneous oxygen saturation (SpO2) during rest and exercise were
assessed. [Results] The placebo group showed no obvious change in ventilation measurements
at rest or during exercise. However, in the PESE group, TV, Te, and Ttot significantly
increased, while RR and VD/VT significantly decreased during exercise compared with the
baseline measurements. Borg scores, SpO2, VO2, or VCO2
did not differ significantly. [Conclusion] PESE improves the ventilation pattern during
rest and exercise. Furthermore, PESE does not increase VO2, which may indicate
an increased workload. Biofeedback may contribute to PESE effects. Stimulation applied
during expiration may evoke sensations increasing prolonged expiration awareness,
facilitating prolongation.
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