Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial

Dreher, Michael; Storre, Jan Hendrik; Windisch, Wolfram

doi:10.1183/09031936.00075806

Cited by 101 publications

(117 citation statements)

References 34 publications

(63 reference statements)

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“…Furthermore, it has been reported that, in chronic hypercapnic COPD under long-term ventilatory support, high-intensity NPPV can also be administered during walking, with ventilator settings unchanged compared with those used at rest, resulting in improved oxygenation, decreased dyspnoea and increased walking distance. Therefore, NPPV during walking could prevent hypoxia-induced complications [95].…”

Section: Nppv As a Coadjuvant Of Prmentioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD

Clini

Ambrosino²

2008

European Respiratory Journal

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Evidence-based guidelines for chronic obstructive pulmonary disease (COPD) have recently been developed.Nonpharmacological treatments have evolved rapidly as an essential part of COPD therapy. They are especially important as complementary interventions in severe or very severe disease, when there is loss in function, a reduction in quality of life and when psychological impairments further complicate the disease.The present article discusses the most used nonpharmacological treatments for severe COPD patients (rehabilitation, long-term oxygen therapy, surgery, noninvasive positive pressure ventilation and supportive nutrition) and their evidence-based usefulness in promoting strategies that relieve symptoms.All of these interventions are used during end-stage disease, to promote self-efficacy, relieve symptoms and prevent further deterioration. These therapeutic options support physicians and allied professionals in improving symptom management for their patients.

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Section: Nppv As a Coadjuvant Of Prmentioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD

Clini

Ambrosino²

2008

European Respiratory Journal

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“…In this setting, oxygenation, dyspnea, and walking distance were substantially improved when NIV was added to supplemental oxygen. 79 One study on subjects with stable hypercapnic COPD directly compared the new concept of high-intensity NIV (mean IPAP 29 cm H 2 O) with the conventional approach using considerably lower IPAP (mean IPAP 15 cm H 2 O), which has been termed low-intensity NIV. 80 In this randomized crossover trial, the mean treatment effect between low-and high-intensity NIV, both used for 6 weeks at home, was Ͼ 9 mm Hg for nocturnal P aCO 2 , which served as the primary outcome, in favor of high-intensity NIV.…”

Section: High-intensity Niv In Copdmentioning

confidence: 99%

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

et al. 2015

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During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous European experts took part in this session and discussed (1) NIV in amyotrophic lateral sclerosis (when to start NIV, NIV and sleep, secretion management, and what to do when NIV fails), (2) recent insights in NIV and COPD (high-intensity NIV, NIV in addition to exercise training, and NIV during exercise training), (3) monitoring of NIV (monitoring devices, built-in ventilator software, leaks, and asynchronies) and identifying events during NIV; and (4) recent and future developments in NIV (target-volume NIV, electromyography-triggered NIV, and autoregulating algorithms)

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“…In addition, PAV increased endurance capacity more than the other interventions. More recently, a study by DREHER et al [9] showed that by applying high inspiratory pressures, the walking distance could be increased in patients with severe COPD. In this study, it was remarkable that the high inspiratory pressures needed by the patients during the night did not have to be adjusted during walking.…”

Section: Ventilatory Support During Exercise or Exercise Trainingmentioning

confidence: 99%

New tools in pulmonary rehabilitation

Wijkstra¹,

Wempe²

2011

Eur Respir J

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In patients with more severe chronic obstructive pulmonary disease (COPD), the benefits of rehabilitation might not be clear and, therefore, new treatment options have been developed to increase the benefits of rehabilitation. This review provides an overview of new approaches being developed as an addition to exercise training. In turn, the benefits of adding ventilatory support, oxygen, anabolics or neuromuscular stimulation to a rehabilitation programme will be discussed. While positive benefits for a number of these approaches have been found, many questions remain unsolved. Therefore, at present, we cannot recommend these new tools as part of the routine management of patients with COPD who start a rehabilitation programme.KEYWORDS: Anabolics, neuromuscular stimulation, oxygen, rehabilitation, ventilatory support C urrent literature has shown that pulmonary rehabilitation is effective in patients with chronic obstructive pulmonary disease (COPD) by improving dyspnoea, exercise tolerance and quality of life [1][2][3]. However, in patients with more severe COPD the benefits of rehabilitation might be less; therefore, new treatment options have been developed to increase rehabilitation results. In this review, we will provide an overview of the new approaches to pulmonary rehabilitation that are an addition to exercise training. VENTILATORY SUPPORT DURING EXERCISE OR EXERCISE TRAININGAdvanced COPD is generally characterised by severe airflow limitation, which is frequently associated with hyperinflation. This will especially worsen during exercise when the absence of any flow reserve requires the subject to breath at a higher lung volume to adjust to the increased ventilatory requirements. The work of breathing will be increased, primarily to overcome the intrinsic positive end-expiratory pressures. As during exercise, the increased ventilatory requirements are difficult to sustain, new approaches are needed to assist patients with the mechanical output during exercise. During recent decades, a number of studies have investigated this topic by applying different types of ventilator support during exercise. In 1990, PETROF et al.[4] demonstrated that continuous positive airway pressure (CPAP) reduced inspiratory muscle effort, as indicated by the pressure-time integral of transdiaphragmatic and oesophageal pressure. In addition, they found that dyspnoea improved with CPAP in five out of the eight patients and that the amelioration of dyspnoea was directly related to reductions in the pressure-time integral of the oesophageal pressure. O'DONNELL et al. [5] showed that by applying 4-5 cmH 2 O of CPAP to patients with COPD (mean forced expiratory volume in 1 s (FEV1) 1.2 L), less breathlessness was experienced during steady-state submaximal exercise. In addition, they showed that similar levels of CPAP administered to patients with even more severe COPD (mean FEV1 0.9 L) improved the patient's endurance capacity during constant power cycle exercise by 48% [6]. A study comparing inspiratory pressure suppo...

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Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial

Cited by 101 publications

References 34 publications

Nonpharmacological treatment and relief of symptoms in COPD

Nonpharmacological treatment and relief of symptoms in COPD

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

New tools in pulmonary rehabilitation

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