Non-invasive ventilation (NIV) as an aid to rehabilitation in acute respiratory disease

Abstract

BackgroundNon-invasive ventilation (NIV) can increase exercise tolerance, reduce exercise induced desaturation and improve the outcome of pulmonary rehabilitation in patients with chronic respiratory disease. It is not known whether it can be applied to increase exercise capacity in patients admitted with non-hypercapnic acute exacerbations of COPD (AECOPD). We investigated the acceptability and feasibility of using NIV for this purpose.MethodsOn a single occasion, patients admitted with an acute exacerbation of chronic respiratory disease who were unable to cycle for five minutes at 20 watts attempted to cycle using NIV and their endurance time (Tlim) was recorded. To determine feasibility of this approach in clinical practice patients admitted with AECOPD were screened for participation in a trial of regular NIV assisted rehabilitation during their hospital admission.ResultsIn 12 patients tested on a single occasion NIV increased Tlim from 184(65) seconds to 331(229) seconds (p = 0.04) and patients desaturated less (median difference = 3.5%, p = 0.029). In the second study, 60 patients were admitted to hospital during a three month period of whom only 18(30)% were eligible to participate and of these patients, only four (7%) consented to participate.ConclusionNIV improves exercise tolerance in patients with acute exacerbations of chronic respiratory disease but the applicability of this approach in routine clinical practice may be limited.Trial registrationhttp://www.controlled-trials.com/ISRCTN35692743

Is there enough room for non-invasive ventilation in pulmonary rehabilitation?

“…More recently, a reliable group of experts have strongly recommended the initiation of PR during and shortly after an exacerbation-related hospitalisation, as this results in clinically relevant improvements in exercise performance, lower-limb muscle function, balance and quality of life compared to usual care [31]. NIV can improve exercise tolerance with less desaturation in patients admitted to hospital with an exacerbation of chronic respiratory disease, but participation is limited in older populations; it is more suitable in younger patients with fewer comorbidities [32].…”

Non invasive ventilation as an additional tool for exercise training

“…Non invasive ventilation improves exercise tolerance in patients with acute exacerbations of chronic respiratory diseases, but the applicability of this approach in routine clinical practice may be limited [ 65 , 66 ]. In patients with restrictive disorders exercise training including NIV was shown to be feasible at home, whatever the modalities [ 67 ].…”

Admission prevention in COPD: non-pharmacological management

“…In the future, we may target these patients during the exacerbation as inpatients. Acknowledging that these patients have very high levels of dyspnea during this period, which prevents exercise, novel use of technologies that accommodate for or modify dyspnea, such as neuromuscular electrical stimulation [ 55 ] and non-invasive ventilation [ 56 ], have been used as adjuncts to exercise training in pilot studies, but further work is required.…”