Effect of high flow nasal cannula on peripheral muscle oxygenation and hemodynamic during paddling exercise in patients with chronic obstructive pulmonary disease: a randomized controlled trial

Fang, Tien-Pei; Chen, Yen-Huey; Hsiao, Hsiu-Feng; Cho, Hsiu-Ying; Tsai, Ying‐Huang; Huang, Chung-Chi; Hsieh, Meng‐Jer; Wu, Huang-Pin; Lin, Hui-Ling

doi:10.21037/atm.2020.03.87

Cited by 7 publications

(7 citation statements)

References 36 publications

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“…We found three ongoing studies. We excluded 35 reports and finally included 5 studies (Fang et al., 2020; Hsiao et al, 2018; Tung et al., 2020; Vitacca et al., 2019; Volpi et al., 2022) with 8 reports, as two studies had more than one associated publication. See the PRISMA flow diagram in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were RCT. Three studies were conducted in Taiwan (Fang et al., 2020; Hsiao et al, 2018; Tung et al., 2020) and two in Italy (Vitacca et al., 2019; Volpi et al., 2022). The studies included 300 patients with COPD.…”

Section: Resultsmentioning

confidence: 99%

“…In this comparison, we included five studies with 300 participants (Fang et al., 2020; Hsiao et al, 2018; Tung et al., 2020; Vitacca et al., 2019; Volpi et al., 2022).…”

Section: Resultsmentioning

confidence: 99%

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High‐flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

Oltra,

Ricciardelli,

Virgilio

et al. 2024

Physiotherapy Res Intl

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BackgroundChronic obstructive pulmonary disease (COPD) is an increasingly concerning global public health issue due to its high burden of morbidity and mortality. Pulmonary rehabilitation (PR) is a comprehensive intervention to improve patients' physical and psychological conditions, commonly involving oxygen supplementation. The potential benefits of high‐flow nasal cannula (HFNC) have recently sparked interest as oxygen therapy. In this context, this study aims to assess the effects of HFNC during the exercise training component of a PR program in people with COPD.MethodsSystematic review (CRD42022330929). We included randomised controlled trials (RCTs), including crossover RCTs with adults with stable COPD. We included trials using oxygen therapy with HFNC during the exercise training component of a PR programme. Primary outcomes: disease‐specific health‐related quality of life (HRQoL), exercise capacity (EC) and adverse events. Secondary outcomes: treatment adherence, breathlessness and future exacerbations.ResultsWe included five studies with 300 participants with moderate to severe COPD. The certainty of the evidence was primarily low or very low for all outcomes of interest due to risk of bias, inconsistency or imprecision. HFNC has little to no difference in HRQoL (4 studies, 129 participants, MD 0.17, 95% CI −1.20 to 1.54; I2 50%). HFNC may result in little to no difference in EC (3 studies, 212 participants, mean difference 18.73, 95% CI −20.49 to 28.94; I2 56%), and we are uncertain about the effect of HFNC on breathlessness (4 studies; 244 participants, MD of −0.07, 95% CI −0.4 to 0.26; I2 63%). Only one study with 44 participants reported a participant's withdrawal because of progressive dyspnoea during lower limb exercise.ConclusionsWe are uncertain about the effect of HFNC during the exercise component of a PR programme in HRQoL, EC or dyspnoea compared to usual care or conventional supplementary oxygen. Non‐domiciliary oxygen patients showed improvements in HRQoL, EC and dyspnoea.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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High‐flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

Oltra,

Ricciardelli,

Virgilio

et al. 2024

Physiotherapy Res Intl

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“…In another RCT of 32 moderate to severe stable COPD patients, Fang et al compared the effect of HFO to conventional nasal oxygen supplementation on peripheral muscle oxygenation and hemodynamics during paddling exercise. 25 The HFO arm achieved better hemodynamics than the nasal oxygen arm as demonstrated by a higher cardiac index (CI) which was the primary outcome. Another trial in Argentina (ClinicalTrials.gov ID NCT02973945), with an intended 60 COPD patients, comparing the use of HFO against 40% oxygen supplementation via Venturi mask during pulmonary rehabilitation is underway.…”

Section: Discussionmentioning

confidence: 99%

High flow nasal oxygen versus usual care in improving pulmonary rehabilitation outcomes of chronic obstructive pulmonary disease patients after an exacerbation - a pilot randomized controlled trial

Mok,

Foong,

Wong

et al. 2023

Proceedings of Singapore Healthcare

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Introduction Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients experience difficulties participating in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR post-COPD exacerbation. Methods We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for COPD exacerbation were enrolled and randomized to either HFO or usual care during an early 6-weeks, outpatient PR program. Results Twenty two patients were randomized between May 2019 to Dec 2019 and 18 patients completed the study. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in 6-min walk distance (6MWD) being 30 m (95% CI: −23 m to 84 m), although this was not statistically significant. All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending ≥75% of exercise sessions). HFO was well tolerated with no adverse events reported. Conclusion This pilot RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early PR on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO’s benefits and has the potential to change PR practice.

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“…In this context, previous studies have reported that patients with COPD who exercised with HFNC support exhibited an extended exercise time and greater peripheral oxygen extraction than those using traditional oxygen equipment [16,20], suggesting a potential decrease in COB associated with HFNC support. Conversely, a recent meta-analysis of this therapeutic tool in respiratory rehabilitation of patients with CCDs did not show a positive impact on lung mechanics, breathing patterns, and exercise capacity [21].…”

Section: Introductionmentioning

confidence: 96%

Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors

Contreras-Briceño,

Espinosa-Ramírez,

Rivera-Greene

et al. 2023

Biosensors

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Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m−2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min−1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E−1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5′ (p < 0.05). Hyperventilation was higher in CTRL since 10′ (p < 0.05). The ∇SmO2·V˙E−1 decreased during exercise, being lowest in CTRL since 5′. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.

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Effect of high flow nasal cannula on peripheral muscle oxygenation and hemodynamic during paddling exercise in patients with chronic obstructive pulmonary disease: a randomized controlled trial

Cited by 7 publications

References 36 publications

High‐flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

High‐flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

High flow nasal oxygen versus usual care in improving pulmonary rehabilitation outcomes of chronic obstructive pulmonary disease patients after an exacerbation - a pilot randomized controlled trial

Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors

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