Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation

Cirio, Serena; Piran, Manuela; Vitacca, Michele; Piaggi, Giancarlo; Ceriana, Piero; Prazzoli, Matteo; Paneroni, Mara; Carlucci, Annalisa

doi:10.1016/j.rmed.2016.08.004

Cited by 69 publications

(72 citation statements)

References 16 publications

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“…In contrast to the results of the present study, Cirio et al . found an increase in endurance time with NHF . In that study, the patients carried out the control test using a Venturi mask relayed to air or oxygen with the aim of providing the same FiO 2 in both conditions.…”

Section: Discussionmentioning

confidence: 99%

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Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

et al. 2019

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Background and objective: We hypothesized that by reducing respiratory work and improving gas exchange, nasal high flow (NHF) would improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) following respiratory exacerbation. Methods: This was a monocentric, randomized, controlled crossover study. Patients with severe to very severe COPD carried out two high-intensity constant work-rate exercise tests (CWRET) with and without NHF on two consecutive days. The primary outcome was the mean difference in endurance time between both conditions. The secondary aims included vastus lateralis oxygenation (StO 2 ), dyspnoea, leg discomfort, maximal inspiratory pressure (MIP), transcutaneous CO 2 pressure (PtcCO 2 ), respiratory rate (RR), heart rate (HR) and pulsed O 2 saturation (SpO 2 ), as well as the patients' opinions of the device. Results: A total of 19 patients were included (mean forced expiratory volume in 1 s = 28.7 AE 10.8%, age = 62.1 AE 9.1 years). No significant differences in endurance time during the CWRET were found between the two test conditions (−66.58 (95% CI: −155.9 to 22.7) s, P = 0.12). StO 2 , PtCO 2 and HR were reduced at the end of the exercise with NHF (−2.1% (95% CI: −4.3 to −0.0); −1.3 mm Hg (95% CI: −2.5 to −0.2); −2.7 bpm (95% CI: −5.0 to −0.5), respectively, P ≤ 0.05). No significant differences were found for any of the other secondary outcomes. Half of the patients evaluated the device as being moderately to very uncomfortable.Conclusion: NHF during exercise did not increase endurance time in patients with COPD following exacerbation.Clinical trial registration: NCT03058081 at clinicaltrials. gov Key words: chronic obstructive pulmonary disease, exercise, muscle oxygenation, nasal high flow, pulmonary rehabilitation.

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Section: Discussionmentioning

confidence: 99%

“…The physiological effects of NHF could help to improve exercise tolerance in those with COPD and requires less technical expertise than NIV. A pilot study showed improvements in endurance, oxygenation and dyspnoea with NHF . However, that study compared NHF with a Venturi mask which is not commonly used in rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

et al. 2019

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“…Above a flow of 20 L/min, HFNC generates a positive pressure in the upper airways [74], inducing an increase in alveolar ventilation, improvements in gas exchange and a reduction in WOB in patients with COPD [75, 76]. Preliminary reports indicate that HFNC may improve exercise performance, oxygen saturation and perceived symptoms in patients with severe COPD and ventilatory limitation [77]. Whether these preliminary results can also be applied to patients with CVF should be the object of future research.…”

Section: Potential Alternatives and Future Applicationsmentioning

confidence: 99%

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

Vitacca

Ambrosino

2018

Respiration

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Background: Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients’ symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. Objective: This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. Methods: We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords “chronic respiratory failure AND exercise,” “non invasive ventilation AND exercise,” “pulmonary rehabilitation” and “exercise training.” Results: Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. Conclusion: We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.

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“…These mechanisms lead to improved exercise performance with fewer symptoms and better gas exchange [85,88,89], improved lung mechanics [90] with less respiratory muscle load [91] and less work of breathing [86]. Since NIV is used currently as a treatment option in patients with COPD and chronic hypercapnia [92], it seems that NHF could be used instead of NIV in the least tolerant and compliant patients, or in association with NIV, to reduce mask-related side-effects [89].…”

Section: No Benefitmentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation

Cited by 69 publications

References 16 publications

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

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