Bilevel Noninvasive Ventilation During Exercise Reduces Dynamic Hyperinflation and Improves Cycle Endurance Time in Severe to Very Severe COPD

被引：11

作者：

Dennis, Clancy J. ^{[1
]}

Menadue, Collette ^{[3
]}

Schneeberger, Tessa ^{[6
,7
]}

Leitl, Daniela ^{[6
,7
]}

Schoenheit-Kenn, Ursula ^{[6
]}

Hoyos, Camilla M. ^{[2
,4
]}

Harmer, Alison R. ^{[1
]}

Barnes, David J. ^{[1
,3
]}

Koczulla, Andreas R. ^{[6
,7
,8
]}

Kenn, Klaus ^{[6
,7
]}

Alison, Jennifer A. ^{[1
,5
]}

机构：

[1] Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia

[2] Univ Sydney, Sch Psychol, Sydney, NSW, Australia

[3] Royal Prince Alfred Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia

[4] Ctr Sleep & Chronobiol, Woolcock Inst Med Res, Sydney, NSW, Australia

[5] Allied Hlth, Sydney Local Hlth Dist, Sydney, NSW, Australia

[6] Schoen Klin Berchtesgadener Land, Inst Pulm Rehabil Res, Schoenau, Germany

[7] Philipps Univ Marburg, Dept Pulm Rehabil, German Ctr Lung Res DZL, Marburg, Germany

[8] Paracelsus Med Univ, Teaching Hosp, Salzburg, Austria

来源：

CHEST | 2021年 / 160卷 / 06期

关键词：

KEY WORDS; COPD; dynamic hyperinflation; exercise; noninvasive ventilation; pulmonary rehabilitation;

D O I：

10.1016/j.chest.2021.06.050

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: During exercise, dynamic hyperinflation (DH), measured by a reduction in inspiratory capacity (IC), increases exertional dyspnea and reduces functional capacity in many patients with severe COPD. Although noninvasive ventilation (NIV) during exercise can improve exercise duration, the effect on DH is unclear. RESEARCH QUESTIONS: In people with COPD, resting hyperinflation, and evidence of DH during exercise, does bilevel NIV during exercise reduce DH and increase endurance time compared with exercise with no NIV, and does NIV with an individually titrated expiratory positive airway pressure (T-EPAP) reduce DH and increase exercise endurance time more than NIV with standardized EPAP (S-EPAP) of 5 cm H2O? STUDY DESIGN AND METHODS: A randomized crossover trial in which investigators and participants were blinded between NIV interventions was performed. Participants (N 1/4 19; FEV1 of 1.02 +/- 0.24 L (39% +/- 6% predicted) completed three constant work rate endurance cycle tests in random order-no NIV, NIV with S-EPAP, and NIV with T-EPAP-during exercise. Primary outcomes were isotime IC and exercise endurance time. Outcome measures from each intervention were compared at isotime and at end exercise by using a linear mixed-model analysis. RESULTS: Compared with no NIV, isotime IC and endurance time were greater with both NIV with S-EPAP (mean difference: 95% CI, 0.19 L [0.10-0.28]; 95% CI, 153 s [24-280], respectively) and T-EPAP (95% CI, 0.22 L [0.13-0.32]; 95% CI, 145 s [28-259], respectively). There was no difference between NIV with S-EPAP and NIV with T-EPAP. INTERPRETATION: In people with COPD and DH during exercise, NIV during exercise reduced DH and increased cycle endurance time. An S-EPAP of 5 cm H2O was adequate to obtain these benefits. TRIAL REGISTRY: Australian New Zealand Clinical Trials Registry; No.: ACTRN12613000804785;

引用

页码：2066 / 2079

页数：14

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