Physiological changes during low- and high-intensity noninvasive ventilation

Lukácsovits, József; Carlucci, Annalisa; Hill, Nicholas S.; Ceriana, Piero; Pisani, Lara; Schreiber, Annia; Pierucci, Paola; Losonczy, György; Nava, Stefano

doi:10.1183/09031936.00056111

Cited by 95 publications

(86 citation statements)

References 28 publications

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“…However, it may be speculative whether the extent of airflow obstruction in this group would solely explain the diminished HRQOL or whether the effects of NIV by resting the respiratory muscles and reducing the work of breathing during NIV application may lead to an enhanced HRQOL. 23 Respiratory muscle function impairment is known to occur not only in subjects with COPD with hypercapnic respiratory failure but also in subjects with COPD in early disease stages, 24,25 and NIV application may therefore account for HRQOL benefits. It is of interest that the NIV group still presented with elevated P aCO 2 levels when compared with the LTOT group despite highintensity NIV, aiming to reduce P aCO 2 to normal values.…”

Section: Hrqolmentioning

confidence: 99%

The Severe Respiratory Insufficiency Questionnaire for Subjects With COPD With Long-Term Oxygen Therapy

et al. 2016

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BACKGROUND: Respiratory insufficiency in COPD may present as hypoxic and/or hypercapnic respiratory failure treated with long-term oxygen therapy (LTOT) and/or noninvasive ventilation (NIV) with LTOT. The Severe Respiratory Insufficiency Questionnaire (SRI) is a tool for the assessment of health-related quality of life (HRQOL) in subjects receiving NIV. However, it remains unclear whether the SRI is also capable of assessing and discriminating HRQOL in subjects receiving LTOT. METHODS: Stable subjects with COPD receiving LTOT or NIV ؉ LTOT (NIV) were prospectively recruited and completed the SRI, lung function tests, and blood gases. Confirmatory factor analysis for construct validity and internal consistency reliability were calculated. RESULTS: One hundred fifty-five subjects were included (113 LTOT, 42 NIV). The Cronbach ␣ coefficient of the 7 subscales ranged between 0.69 and 0.89 (LTOT) and between 0.79 and 0.93 (NIV), respectively. In both groups, confirmatory factor analysis revealed a one-factor model for the SRI summary scale; in 5 subscales, one-or 2-factor models could be established. Group differences in the SRI subsets were all P <.05 (except for physical functioning) with higher scores in subjects receiving NIV. CONCLUSIONS: The SRI showed high reliability and validity in subjects with COPD receiving LTOT. Subjects receiving LTOT had lower SRI scores, indicating a poorer HRQOL compared with subjects with established NIV and LTOT. Key words: quality of life; COPD; oxygen inhalation therapy; noninvasive ventilation; chronic air flow obstruction; severe respiratory insufficiency questionnaire (SRI). [Respir Care 2016;61(9):1186 -1191.

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Section: Hrqolmentioning

confidence: 99%

The Severe Respiratory Insufficiency Questionnaire for Subjects With COPD With Long-Term Oxygen Therapy

et al. 2016

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“…Another very recent physiological randomised crossover study confirmed that high-intensity NPPV is more effective than conventional (low-intensity) NPPV in improving gas exchange and in reducing inspiratory effort [33]. However, this study also revealed that high-intensity NPPV may induce a reduction in cardiac output.…”

Section: Conventional (Low-) Versus High-intensity Nppv: Rctsmentioning

confidence: 54%

“…Several trials have now established this concept for COPD patients [11,17,[24][25][26][27][28][29][30][31][32][33]. For the purpose of maximally decreasing elevated Pa,CO 2 values, controlled ventilation with high IPAP levels typically ranging 20-40 cmH 2 O is implemented in the hospital setting and subsequently used for HMV.…”

Section: High-intensity Nppv Definitionmentioning

confidence: 99%

“…Although complex treatment modalities often require an individually adapted procedure, the single steps necessary for initiating high-intensity NPPV have a typical Table 3 Physiological and clinical effects of high-intensity noninvasive positive pressure ventilation (NPPV) [11,17,[24][25][26][27][28][29][30][31][32][33] NPPV using assisted ventilation with low IPAP order as listed in table 4. This approach is successful in the majority of cases and can be used as guidance, particularly by beginners.…”

Section: Conventional (Low-) Versus High-intensity Nppv: Rctsmentioning

confidence: 99%

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Noninvasive positive pressure ventilation in COPD

Windisch

2011

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“…From the studies performed in CRF we have learnt that higher inspiratory pressures are necessary to improve gas exchange. However, we are insufficiently informed about probable disadvantages of this high-intensity NIV [Lukácsovits et al 2012]. In the study of Struik and colleagues the highest pressures were used indeed leading to improved gas exchange while clear benefits in terms of survival or readmission rates did not result [Struik et al 2014b].…”

Section: Introductionmentioning

confidence: 99%

The role of NIV in chronic hypercapnic COPD following an acute exacerbation: the importance of patient selection?

Duiverman

Windisch

Storre

et al. 2016

Ther Adv Respir Dis

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Abstract:Recently, clear benefits have been shown from long-term noninvasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure. In our opinion, these benefits are confirmed and nocturnal NIV using sufficiently high inspiratory pressures should be considered in COPD patients with chronic hypercapnic respiratory failure in stable disease, preferably combined with pulmonary rehabilitation. In contrast, clear benefits from (continuing) NIV at home after an exacerbation in patients who remain hypercapnic have not been shown. In this review we will discuss the results of five trials investigating the use of home nocturnal NIV in patients with prolonged hypercapnia after a COPD exacerbation with acute hypercapnic respiratory failure. Although some uncontrolled trials might have shown some benefits of this therapy, the largest randomized controlled trial did not show benefits in terms of hospital readmission or death. However, further studies are necessary to select the patients that optimally benefit, select the right moment to initiate home NIV, select the optimal ventilatory settings, and to choose optimal follow up programmes. Furthermore, there is insufficient knowledge about the optimal ventilatory settings in the post-exacerbation period. Finally, we are not well informed about exact reasons for readmission in patients on NIV, the course of the exacerbation and the treatment instituted. A careful follow up might probably be necessary to prevent deterioration on NIV early.

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Physiological changes during low- and high-intensity noninvasive ventilation

Cited by 95 publications

References 28 publications

The Severe Respiratory Insufficiency Questionnaire for Subjects With COPD With Long-Term Oxygen Therapy

The Severe Respiratory Insufficiency Questionnaire for Subjects With COPD With Long-Term Oxygen Therapy

Noninvasive positive pressure ventilation in COPD

The role of NIV in chronic hypercapnic COPD following an acute exacerbation: the importance of patient selection?

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