Inspiratory pressure during noninvasive ventilation in stable COPD: help the lungs, but do not forget the heart

Lukácsovits, József; Nava, Stefano

doi:10.1183/09031936.00173212

Cited by 11 publications

(9 citation statements)

References 6 publications

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“…However, high-intensity NPPV has raised some concerns when focusing on cardiac output [32],as shown in a recent randomised cross-over study [33] assessing the acute physiological effects of low-intensity (Li-) NPPV and Hi-NPPV in 15 patients with stable COPD. While both forms significantly improved gas exchange compared to spontaneous breathing, Hi-NPPV induced a marked lowering in cardiac output [34].…”

Section: Discussionmentioning

confidence: 90%

Nocturnal noninvasive positive pressure ventilation in stable COPD: A systematic review and individual patient data meta-analysis

Struik

Lacasse

Goldstein

et al. 2014

Respiratory Medicine

130

101

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Section: Discussionmentioning

confidence: 90%

Nocturnal noninvasive positive pressure ventilation in stable COPD: A systematic review and individual patient data meta-analysis

Struik

Lacasse

Goldstein

et al. 2014

Respiratory Medicine

130

101

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“…Patients with COPD are at increased risk of dying from cardiovascular complications following exercise-induced hypoxemia; thus interventions to reduce dyspnea, the hypoxemic and cardiac output, burden may be of clinical importance ( 46 ). Use of NPPV has been illustrated to improve exercise tolerance ( 47 ) and cardiac output in patients with COPD ( 43 ); this improvement was more prominent in Hi-NPPV strategy ( 48 ), even though this is speculative, as a reduction in cardiac output may simply refl ect that the heart is more "rested" because of reduced oxygen consumption that results from rested respiratory muscles. NPPV has been used as an aid to exercise training in COPD patients.…”

Section: Exercisementioning

confidence: 98%

Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD

Altıntaş

2015

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature. In addition, long-term NPPV reportedly failed in the classic trials to improve important physiological parameters such as arterial blood gases, which might serve as an explanation as to why long-term NPPV has not been shown to substantially impact on survival. However, high intensity NPPV (HI-NPPV) using controlled NPPV with the highest possible inspiratory pressures tolerated by the patient has recently been described as a new and promising approach that is well-tolerated and is also capable of improving important physiological parameters such as arterial blood gases and lung function. This clearly contrasts with the conventional approach of low-intensity NPPV (LI-NPPV) that uses considerably lower inspiratory pressures with assisted forms of NPPV. Importantly, HI-NPPV was very recently shown to be superior to LI-NPPV in terms of improved overnight blood gases, and was also better tolerated than LI-NPPV. Furthermore, HI-NPPV, but not LI-NPPV, improved dyspnea, lung function and disease-specific aspects of health-related quality of life. A recent study showed that long-term treatment with NPPV with increased ventilatory pressures that reduced hypercapnia was associated with significant and sustained improvements in overall mortality. Thus, long-term NPPV seems to offer important benefits in this patient group, but the treatment success might be dependent on effective ventilatory strategies.

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“…However, the adverse cardiovascular effects of HI‐NIV, due to increased intrathoracic pressure resulting in reduced venous return with a subsequent reduction in cardiac output and increased pulmonary vascular resistance, need to be considered carefully. Although the application of HI‐NIV is associated with an acute fall in cardiac output, it should be noted that medium‐term cardiovascular safety, in terms of echocardiographic measures of cardiac function, has been demonstrated …”

Section: Home Niv and Ltot In Stable Copd Patients With Chronic Respimentioning

confidence: 99%

Home mechanical ventilation for chronic obstructive pulmonary disease: What next after the HOT‐HMV trial?

2019

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The benefits of acute non-invasive ventilation to treat acidotic exacerbations of chronic obstructive pulmonary disease (COPD) are well-established. Until recently, the evidence for home mechanical ventilation (HMV) to treat patients with stable COPD had been lacking. This has subsequently been addressed by the application of higher levels of pressure support combined with targeted management of chronic respiratory failure, which demonstrated a reduction in all-cause mortality. Similarly, the previous trial of home oxygen therapy (HOT) and HMV delivered following an acute exacerbation failed to demonstrate an improvement in outcome. With the focus on patients with persistent hypercapnic respiratory failure in the recovery phase following a life-threatening exacerbation combined with targeted reduction in carbon dioxide, HOT and HMV (HOT-HMV) was shown to be clinically effective in reducing the time to readmission or death and cost effective in both the United Kingdom and United States healthcare systems. Future work will need to focus on promoting adherence to home ventilation and novel auto-titrating ventilator modes to facilitate and optimize the set-up of overnight ventilatory support in different target population such as COPD patients with obstructive sleep apnoea and COPD patients with episodic nocturnal hypoventilation.

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Inspiratory pressure during noninvasive ventilation in stable COPD: help the lungs, but do not forget the heart

Cited by 11 publications

References 6 publications

Nocturnal noninvasive positive pressure ventilation in stable COPD: A systematic review and individual patient data meta-analysis

Nocturnal noninvasive positive pressure ventilation in stable COPD: A systematic review and individual patient data meta-analysis

Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD

Home mechanical ventilation for chronic obstructive pulmonary disease: What next after the HOT‐HMV trial?

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