Noninvasive Mechanical Ventilation Improves Endurance Performance in Patients With Chronic Respiratory Failure Due to Thoracic Restriction

Schönhofer, Bernd; Wallstein, Sven; Wiese, C.; Köhler, Dieter

doi:10.1378/chest.119.5.1371

Cited by 47 publications

(32 citation statements)

References 20 publications

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“…In a 3-month prospective controlled trial, SCHONHOFER et al [28] showed a significant improvement in endurance time in three different tests in the NPPV group compared with controls. Endurance time increased by 278¡269% during an inspiratory threshold loading test, by 176¡159% during a cycle ergometer test, and by 32¡22% during a shuttle walking test.…”

Section: Contraindicationsmentioning

confidence: 98%

Noninvasive ventilation for chest wall and neuromuscular disorders

Shneerson¹,

Simonds²

2002

Eur Respir J

161

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Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis).If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative.There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that “prophylactic” ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease.There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is ∼90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.

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Section: Contraindicationsmentioning

confidence: 98%

Noninvasive ventilation for chest wall and neuromuscular disorders

Shneerson¹,

Simonds²

2002

Eur Respir J

161

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“…In one study, after three months of nocturnal ventilatory support, cycling and walking endurance times increased markedly. 22 Non-invasive ventilation has also been used during exercise in order to improve exercise tolerance. This has been achieved successfully in one report, 23 but there were methodological problems with this study and the results have not been replicated in patients with similar disorders.…”

Section: Treatment Of Chronic Hypercapnic Respiratory Failurementioning

confidence: 99%

Respiratory failure in tuberculosis: a modern perspective

Shneerson

2004

Clinical Medicine

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-Acute respiratory failure is more common in miliary tuberculosis than in tuberculous bronchopneumonia and also has a worse prognosis. Chronic hypercapnic respiratory failure is frequent after both spinal tuberculosis and surgical treatments for pulmonary tuberculosis. It may develop insidiously or present acutely, for instance, during a chest infection. Hypoventilation appears during REM sleep before non-REM sleep or wakefulness and is readily treatable with non-invasive ventilation. The prognosis is good even if initially tracheostomy ventilation is required temporarily.

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“…Similarly, in a group of patients with CRF due to restrictive thoracic disease, 3 months of nocturnal NIV produced a marked increase in endurance time during exercise tests involving respiratory and peripheral muscles. In contrast, in a matched group of controls assigned to normal care, no signifi cant improvement in any test was observed [7]. Reports of the benefi cial effects of nocturnal ventilatory support on exercise endurance have predominantly come from studies involving patients with restrictive chest wall disorders; although in a randomised crossover trial, signifi cant improvements in walking distance were seen in patients with severe cystic fi brosis when using nocturnal bilevel support compared with the control (air) arm [5].…”

Section: Nocturnal Ventilatory Support and Exercise Performancementioning

confidence: 84%

“…While nocturnal ventilatory support was initially introduced with the intention of reversing respiratory failure and reducing symptoms related to hypoventilation, a number of studies have reported accompanying improvements in daytime exercise tolerance and physical activity in the absence of formal exercise training [5][6][7]. In a study of patients with chronic hypercapnic respiratory failure (CRF) with mixed aetiology, a relationship between the severity of daytime hypercapnia and daily activity was found [6].…”

Section: Nocturnal Ventilatory Support and Exercise Performancementioning

confidence: 99%

Noninvasive ventilation as an adjunct to exercise training in patients with chronic respiratory disease

Piper

Menadue

2009

breathe

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Educational aimsTo describe the potential benefits of noninvasive positive-pressure ventilation (NIV) as an adjunct to exercise training in selected patients with chronic obstructive pulmonary disease (COPD) or chest wall restriction.To outline the mechanisms by which NIV may improve exercise performance in selected patients with COPD or chest wall restriction.To identify characteristics of patients with chronic respiratory disease who are more likely to respond to NIV-assisted training.To highlight major practical considerations for implementing NIV-assisted training in an individual with COPD or chest wall restriction.SummarySevere exertional dyspnoea is a major impediment to physical activity and adversely affects quality of life for many individuals with chronic respiratory disease. Although exercise can improve cardiorespiratory and peripheral muscle responses, training at sufficient intensity and duration may be difficult for the very breathless, deconditioned patient. Consequently, strategies to optimise training for such individuals are gaining interest. NIV is one such option and there is a growing body of evidence outlining its benefits in selected patients. However, the technique is not without its constraints and problems. An understanding of the mechanisms underlying improvements in exercise performance with NIV-assisted training is important in targeting appropriate candidates for intervention and identifying the best therapy to achieve the maximum benefit.

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Noninvasive Mechanical Ventilation Improves Endurance Performance in Patients With Chronic Respiratory Failure Due to Thoracic Restriction

Cited by 47 publications

References 20 publications

Noninvasive ventilation for chest wall and neuromuscular disorders

Noninvasive ventilation for chest wall and neuromuscular disorders

Respiratory failure in tuberculosis: a modern perspective

Noninvasive ventilation as an adjunct to exercise training in patients with chronic respiratory disease

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