Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease

Martín, Eduardo Márquez; Ruiz, Francisco Órtega; Ramos, Pilar Cejudo; Lόpez-Campos, José Luís; Azcona, Borja Valencia; Cortés, Emilia Barrot

doi:10.1016/j.rmed.2014.10.005

Cited by 31 publications

(37 citation statements)

References 45 publications

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“…In another study, COPD patients were randomized into three groups for a 12‐week intervention: ET alone, NIV alone and combined treatment. All measures of exercise capacity improved after training alone and the combined treatment, with inflammatory markers improving only with the combined treatment . Another study showed that 20 cm H 2 O IPAP during treadmill walking in patients with severe kyphoscoliosis increased endurance time, pattern of breathing and oxygenation, while reducing the perception of leg muscle fatigue and dyspnoea as compared with unassisted exercise …”

Section: Discussionmentioning

confidence: 99%

“…The study by Bianchi et al 30 recruited milder patients and used lower levels of ventilatory support than the study by Hawkins et al, 31 differences which may have contributed to the conflicting findings of these studies. In another study, 32 COPD patients were randomized into three groups for a 12-week intervention: ET alone, NIV alone and combined treatment. All measures of exercise capacity improved after training alone and the combined treatment, with inflammatory markers improving only with the combined treatment.…”

Section: Discussionmentioning

confidence: 99%

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Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

et al. 2017

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Background and objective: The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. Methods: All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. Results: Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 AE 973 vs 51 AE 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. Conclusion: In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

et al. 2017

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“…In the study by KÖHNLEIN et al [36], a decrease in emergency hospital admissions was observed in the NIV group when compared to the control group (2.2 and 3.1 exacerbations per patient per year, respectively). Seven RCTs evaluated HRQL with a follow-up period ranging between 3 and 12 months; the pooled analysis demonstrated that HRQL was higher with NIV (SMD 0.49 higher, 95% CI 0.01 lower to 0.98 higher; very low certainty) [31, 36,39,43,46,47,50]. Included studies had to use one of the multiple validated scales/questionnaires in this population to assess HRQL.…”

Section: For Cliniciansmentioning

confidence: 99%

“…They showed that the NIV group significantly increased walking distance when compared to the other conditions. Marquez-Martin et al [50] performed an RCT over 12 weeks comparing groups allocated to either PR, NIV or PR+NIV. Patients reportedly received 6 to 8 h per night of NIV.…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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“…Mean training intensity and peak work rate after training were higher and lactate at iso-workload after training was reduced more in the group under PAV [53]. Exercise training with NIV was associated with a reduction in inflammatory markers in patients with COPD [54]. Other RCTs have confirmed the benefits of NIV during exercise training [55-57] and during exercise training with the addition of heliox or inspiratory muscle training [58, 59].…”

Section: Niv and Exercise Training Programmesmentioning

confidence: 99%

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

Vitacca

Ambrosino

2018

Respiration

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Background: Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients’ symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. Objective: This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. Methods: We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords “chronic respiratory failure AND exercise,” “non invasive ventilation AND exercise,” “pulmonary rehabilitation” and “exercise training.” Results: Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. Conclusion: We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.

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Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease

Cited by 31 publications

References 45 publications

Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

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