Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients

Goulart, Cássia da Luz; Caruso, F.; Araújo, Adriana; Arêas, Guilherme Peixoto Tinoco; Moura, Sílvia Cristina Garcia de; Catai, Aparecida Maria; Mendes, Renata Gonçalves; Phillips, Shane A.; Arena, Ross; Silva, Andréa Lúcia Gonçalves da; Borghi‐Silva, Audrey

doi:10.1016/j.rmed.2020.106173

Cited by 16 publications

(14 citation statements)

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“…In addition, the clinical utility of the FMD measurement, with cutoff points determined even on the first day of hospitalization of patients with COVID-19, is potentially viable simple and rapid measure to determine severity and risks, as well as assess the effects of pharmacological interventions and non-pharmacological and direct therapies. Thus, noninvasive measures of endothelial dysfunction can help health professionals introduce interventions aimed at improving endothelial function through interventions such as noninvasive ventilation, respiratory care ( 31 ) and aerobic exercise training ( 32 ). These interventions can provide a decrease in arterial resistance ( 33 ) and to increased nitric oxide synthesis and bioavailability ( 34 ), thus improving the local muscle response and favoring the activity of the endothelium in smooth muscle cells; in addition to positively impacting hemodynamic responses ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

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Goulart

et al. 2021

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

Oliveira

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Goulart

et al. 2021

Respiratory Medicine

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“…Thus, bulk blood flow to the legs may have been enhanced by PAV despite a faster decrease in Q T , which would tend to reduce convective O 2 delivery at a given time point. The positive effects of PAV on muscle blood flow during high-intensity exercise may have persisted throughout the recovery phase, leading to more pronounced post-exercise hyperemia ( Goulart et al, 2020a ).…”

Section: Discussionmentioning

confidence: 99%

“…In this context, a previous study has shown that unloading the respiratory musculature with proportional assist ventilation (PAV) was associated with improved peripheral muscle oxygenation during constant-load exercise, as indicated by blunted changes in Δ deoxyhemoglobin ([deoxi-Hb + Mb]) determined by near-infrared spectroscopy (NIRS) and longer exercise tolerance in patients with HFrEF ( Borghi-Silva et al, 2008a ), chronic obstructive pulmonary disease (COPD) ( Borghi-Silva et al, 2008b ), and HFrEF-COPD coexistence ( da Luz Goulart et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Proportional Assist Ventilation Improves Leg Muscle Reoxygenation After Exercise in Heart Failure With Reduced Ejection Fraction

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BackgroundRespiratory muscle unloading through proportional assist ventilation (PAV) may enhance leg oxygen delivery, thereby speeding off-exercise oxygen uptake (V.⁢O2) kinetics in patients with heart failure with reduced left ventricular ejection fraction (HFrEF).MethodsTen male patients (HFrEF = 26 ± 9%, age 50 ± 13 years, and body mass index 25 ± 3 kg m2) underwent two constant work rate tests at 80% peak of maximal cardiopulmonary exercise test to tolerance under PAV and sham ventilation. Post-exercise kinetics of V.⁢O2, vastus lateralis deoxyhemoglobin ([deoxy-Hb + Mb]) by near-infrared spectroscopy, and cardiac output (QT) by impedance cardiography were assessed.ResultsPAV prolonged exercise tolerance compared with sham (587 ± 390 s vs. 444 ± 296 s, respectively; p = 0.01). PAV significantly accelerated V.⁢O2 recovery (τ = 56 ± 22 s vs. 77 ± 42 s; p < 0.05), being associated with a faster decline in Δ[deoxy-Hb + Mb] and QT compared with sham (τ = 31 ± 19 s vs. 42 ± 22 s and 39 ± 22 s vs. 78 ± 46 s, p < 0.05). Faster off-exercise decrease in QT with PAV was related to longer exercise duration (r = −0.76; p < 0.05).ConclusionPAV accelerates the recovery of central hemodynamics and muscle oxygenation in HFrEF. These beneficial effects might prove useful to improve the tolerance to repeated exercise during cardiac rehabilitation.

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“…A potential mechanism that could explain these benefits is the pulmonary mechanical effect that may improve cardiac function and regional vascular distribution ( 45 , 46 ). In addition, recent evidence has demonstrated that NiPPV can also positively modulate heart rate variability during high-intensity exercise in COPD-CHF patients ( 47 ). The use of non-invasive ventilation during high intensity exercise (HIT) is thus recommended when the objective is to quickly emphasize peripheral muscle gains in a rehabilitation program when dyspnea symptoms can be the potential limiting factor for tasks that require greater efforts in these patients.…”

Section: Exercise-based Rehabilitation Delivery Models For Copd-chf Patientsmentioning

confidence: 99%

“…Unfortunately, few studies have evaluated the effect of NiPPV during long-term rehabilitation programs in patients with COPD-CHF. Additionally, da Luz Goulart et al ( 47 ) demonstrated that NiPPV applied through two pressure levels (Bilevel) 8–12 cmH 2 O to inspiratory pressure and 4–6 cmH 2 O for positive end-expiratory pressure produced a marked acute benefit on endothelial function associated with improved exercise tolerance during a bout of high-intensity aerobic exercise in patients with coexisting COPD-HF. The NiPPV improving peripheral oxygenation may also have influenced the local metabolic activity, causing an acute “restoration” of endothelial function in COPD-CHF patients ( 47 ).…”

Section: Exercise-based Rehabilitation Delivery Models For Copd-chf Patientsmentioning

confidence: 99%

Exercise-Based Rehabilitation Delivery Models in Comorbid Chronic Pulmonary Disease and Chronic Heart Failure

Borghi‐Silva

Araújo

Winkermann

et al. 2021

Front. Cardiovasc. Med.

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Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.

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Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients

Cited by 16 publications

References 30 publications

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

Proportional Assist Ventilation Improves Leg Muscle Reoxygenation After Exercise in Heart Failure With Reduced Ejection Fraction

Exercise-Based Rehabilitation Delivery Models in Comorbid Chronic Pulmonary Disease and Chronic Heart Failure

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