Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD

Abstract

BackgroundInspiratory muscle training (IMT) using a Threshold® device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown.ObjectiveTo assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD.MethodsTwenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP.ResultsPatients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions.ConclusionAcute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.

Mapping the global research landscape and hotspot of exercise therapy and chronic obstructive pulmonary disease: A bibliometric study based on the web of science database from 2011 to 2020

“…Rehabilitation engineering for noninvasive monitoring and widespread applications of wearable materials have increasingly become hot topics of concern for COPD researchers. For example, taking the initiative to participate in video games ( Simmich et al, 2019 ), the active use of resistance breath muscle training devices ( Włodarczyk and Barinow-Wojewódzki, 2015 ; Schaper-Magalhães et al, 2017 ; Daynes et al, 2018 ), wearable smart vests ( Naranjo-Hernández et al, 2018 ) and a smartphone oximeter with a fingertip probe ( Chan et al, 2019 ) could effectively monitor the respiratory rate of COPD patients. In addition, using interdisciplinary digital mobility results enabled scientific assessment of the clinical utility of physical activity ( Polhemus et al, 2021 ) and remote rehabilitation systems combined with wearable equipment could help COPD patients to achieve better sports performance and healthy quality of life ( Tey et al, 2017 ).…”