Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: <scp>A</scp> randomized controlled trial

Vitacca, Michele; Kaymaz, Dicle; Lanini, Barbara; Vagheggini, Guido; Ergün, Pınar; Gigliotti, Francesco; Ambrosino, Nicolino; Paneroni, Mara

doi:10.1111/resp.13181

Cited by 31 publications

(19 citation statements)

References 40 publications

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“…Only a few studies with small sample sizes have investigated short‐ or long‐term effects of NIV during exercise including patients with CHRF (range of resting PCO 2 : 50–52 mm Hg). However, all these studies provided only relatively low inspiratory pressure during NIV exercise (IPAP range: 12–17 cm H 2 O).…”

Section: Discussionmentioning

confidence: 99%

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

et al. 2018

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Background and objective Patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnic respiratory failure (CHRF) characteristically have exercise intolerance and limitations in performing conventional training. Therefore, the aim of this study was to investigate the acute effects of non‐invasive ventilation (NIV) as a supportive tool during exercise in CHRF. Methods Two cycle endurance tests (CET) at 60% of the peak work rate were performed. Patients were randomly assigned to cycle in two conditions: (i) high‐pressure NIV (mean inspiratory positive airway pressure: 27 ± 3 cm H2O) along with oxygen supplementation or (ii) control: oxygen‐use only. Transcutaneously measured partial pressure of carbon dioxide (TcPCO2), oxygen saturation and heart rate were continuously recorded. Muscle oxygen availability of intercostal and vastus lateralis muscle was measured during exercise by near‐infrared spectroscopy (NIRS). Results A total of 20 patients with CHRF (forced expiratory volume in 1 s (FEV1): 19 ± 4% predicted, partial pressure of oxygen (PaO2): 55 ± 9 mm Hg, partial pressure of carbon dioxide (PaCO2): 51 ± 7 mm Hg) were recruited in a randomized cross‐over trial. On NIV, COPD patients increased cycle endurance time by 39% compared to oxygen‐use only (663 ± 360 vs 477 ± 249 s, P = 0.013). On NIV, TcPCO2 was significantly lower at rest (44.9 ± 6.2 vs 50.7 ± 6.6 mm Hg, P < 0.001) and at isotime (50.0 ± 5.5 vs 56.1 ± 6.2 mm Hg, P < 0.001). Oxygen availability in the intercostal muscles remained relatively constant with NIV compared to oxygen‐use only. Although patients cycled longer using NIV, a lower increase in exertional dyspnoea at the end of CET (median increase in Borg‐dyspnoea: 2 vs 4, P = 0.003) was reported. Conclusion NIV with high pressures as add‐on to oxygen supplementation increases cycle endurance time, mitigates exertional dyspnoea and limits exercise‐induced hypercapnia in COPD patients with CHRF.

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Section: Discussionmentioning

confidence: 99%

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

et al. 2018

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“…Using non-invasive ventilation (NIV) to enhance exercise performance in patients with respiratory failure has a reasonable physiological rationale, but it has not been shown to improve walking distance 39. The authors, however, combined the results of patients with COPD and kyphoscoliosis, which made it difficult to draw a clear conclusion.…”

Section: Exercise Training Combined With Oxygen Supplementation or Nomentioning

confidence: 99%

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

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Rochester

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et al. 2019

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“…Studies in patients with CVF [23, 53, 62] used only relatively low levels of IPAP (15–17 cm H 2 O) during exercise with NIV. The effectiveness of the proposed pressures as high as needed to reduce PaCO 2 in the long term [7] during exercise training in patients with CVF is still unknown.…”

Section: Some Technical Considerationsmentioning

confidence: 99%

“…The incremental exercise test and dyspnoea improved significantly in both groups. Only patients with NIV improved their respiratory muscle function and leg fatigue, whereas HRQL was significantly improved only in controls [62]. …”

Section: Niv and Exercise Training Programmesmentioning

confidence: 99%

“…Recently, patients with CVF on home nocturnal NIV and long-term oxygen therapy for at least 6 months were studied [62]. Patients of the study group performed NIV during exercise training sessions with the same ventilator, mask (85.7% face mask, 14.3% nasal mask) and, at the start of exercise, ventilatory setting (mean IPAP: 17.4 cm H 2 O; EPAP: 6.5 cm H 2 O; inspiratory time: 1.2 s) as used at home.…”

Section: Niv and Exercise Training Programmesmentioning

confidence: 99%

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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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Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

Cited by 31 publications

References 40 publications

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

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

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