TY - JOUR
T1 - Impact of High-Intensity-NIV on the heart in stable COPD
T2 - A randomised cross-over pilot study
AU - Duiverman, Marieke Leontine
AU - Maagh, Petra
AU - Magnet, Friederike Sophie
AU - Schmoor, Claudia
AU - Arellano-Maric, Maria Paola
AU - Meissner, Axel
AU - Storre, Jan Hendrik
AU - Wijkstra, Peter Jan
AU - Windisch, Wolfram
AU - Callegari, Jens
PY - 2017/5/2
Y1 - 2017/5/2
N2 - 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.
AB - 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.
KW - Chronic obstructive pulmonary disease
KW - Non-invasive ventilation
KW - High-intensity non-invasive ventilation
KW - Cardiac output
KW - Echocardiography
KW - Gas exchange
KW - Lung Function
KW - Health-related Quality of Life
KW - Respiratory muscle activity
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - POSITIVE-PRESSURE VENTILATION
KW - NONINVASIVE MECHANICAL VENTILATION
KW - RIGHT-VENTRICULAR FUNCTION
KW - HYPERCAPNIC COPD
KW - RESPIRATORY-FAILURE
KW - RATE-VARIABILITY
KW - CONTROLLED-TRIAL
KW - STANDARDIZATION
KW - HYPERTENSION
U2 - 10.1186/s12931-017-0542-9
DO - 10.1186/s12931-017-0542-9
M3 - Article
C2 - 28464911
SN - 1465-9921
VL - 18
JO - Respiratory Research
JF - Respiratory Research
IS - 76
ER -