Impact of High-Intensity-NIV on the heart in stable COPD: A randomised cross-over pilot study

Marieke Leontine Duiverman*, Petra Maagh, Friederike Sophie Magnet, Claudia Schmoor, Maria Paola Arellano-Maric, Axel Meissner, Jan Hendrik Storre, Peter Jan Wijkstra, Wolfram Windisch, Jens Callegari

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    48 Citations (Scopus)
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    Abstract

    Background: Although high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients.

    Methods: In a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated.

    Results: Three patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life.

    Conclusions: Long-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output.

    Original languageEnglish
    Number of pages12
    JournalRespiratory Research
    Volume18
    Issue number76
    DOIs
    Publication statusPublished - 2-May-2017

    Keywords

    • Chronic obstructive pulmonary disease
    • Non-invasive ventilation
    • High-intensity non-invasive ventilation
    • Cardiac output
    • Echocardiography
    • Gas exchange
    • Lung Function
    • Health-related Quality of Life
    • Respiratory muscle activity
    • OBSTRUCTIVE PULMONARY-DISEASE
    • POSITIVE-PRESSURE VENTILATION
    • NONINVASIVE MECHANICAL VENTILATION
    • RIGHT-VENTRICULAR FUNCTION
    • HYPERCAPNIC COPD
    • RESPIRATORY-FAILURE
    • RATE-VARIABILITY
    • CONTROLLED-TRIAL
    • STANDARDIZATION
    • HYPERTENSION

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