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Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation.
Respir Med. 2016 09; 118:128-132.RM

Abstract

INTRODUCTION

High flow nasal cannula (HFNC) was shown to washout the anatomical dead space, permitting a higher fraction of minute ventilation to participate in gas pulmonary exchanges. Moreover, it is able to guarantee the desired inhaled oxygen fraction (FiO2) even at high level of patient's minute ventilation by minimizing the room air entrainment. The effect of HFNC has never been investigated on stable severe COPD patients in term of endurance capacity with standardised laboratory tests.

METHOD/DESIGN

We performed, in a randomized crossover study, two constant load exercise tests at the 75% of maximum workload achieved at a previous incremental exercise test on cycle-ergometer: with (HFNC-test) and without HFNC (Control-test). Both constant load tests were fulfilled at the same inhaled oxygen fraction (isoFiO2).

RESULTS

The endurance time significantly increased in the HFNC-test compared to the Control-test (the mean difference between the two groups was 109 ± 104 s, p < 0.015). At iso-time, HFNC-test showed a better oxygen saturation (95 ± 3% vs 89 ± 3%, respectively, p < 0.005) either in the subgroup of patients who used supplemental oxygen and in the subgroup who did not. Moreover, a significantly lower dyspnea (median of 5.5 vs 10, respectively, p = 0.002) and leg fatigue score (median of 5 vs 9.5, p = 0.002) was recorded at iso-time during HFNC-test.

CONCLUSION

HFNC may improve the exercise performance in severe COPD patients with ventilatory limitation. This effect is associated to an improvement of SaO2 and perceived symptoms at iso-time. In a Pulmonary Rehabilitation program HFNC may allow a given high intensity load to be sustained for a longer time with less symptoms.

Authors+Show Affiliations

Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Mazzini 129, Lumezzane, Brescia, 25066, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Mazzini 129, Lumezzane, Brescia, 25066, Italy.Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy. Electronic address: annalisa.carlucci@fsm.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27578482

Citation

Cirio, Serena, et al. "Effects of Heated and Humidified High Flow Gases During High-intensity Constant-load Exercise On Severe COPD Patients With Ventilatory Limitation." Respiratory Medicine, vol. 118, 2016, pp. 128-132.
Cirio S, Piran M, Vitacca M, et al. Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation. Respir Med. 2016;118:128-132.
Cirio, S., Piran, M., Vitacca, M., Piaggi, G., Ceriana, P., Prazzoli, M., Paneroni, M., & Carlucci, A. (2016). Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation. Respiratory Medicine, 118, 128-132. https://doi.org/10.1016/j.rmed.2016.08.004
Cirio S, et al. Effects of Heated and Humidified High Flow Gases During High-intensity Constant-load Exercise On Severe COPD Patients With Ventilatory Limitation. Respir Med. 2016;118:128-132. PubMed PMID: 27578482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation. AU - Cirio,Serena, AU - Piran,Manuela, AU - Vitacca,Michele, AU - Piaggi,Giancarlo, AU - Ceriana,Piero, AU - Prazzoli,Matteo, AU - Paneroni,Mara, AU - Carlucci,Annalisa, Y1 - 2016/08/08/ PY - 2016/05/17/received PY - 2016/07/26/revised PY - 2016/08/07/accepted PY - 2016/9/1/entrez PY - 2016/9/1/pubmed PY - 2018/1/9/medline KW - Chronic obstructive pulmonary disease KW - Chronic respiratory failure KW - Exercise training KW - High flow nasal cannula KW - Oxygen therapy SP - 128 EP - 132 JF - Respiratory medicine JO - Respir Med VL - 118 N2 - INTRODUCTION: High flow nasal cannula (HFNC) was shown to washout the anatomical dead space, permitting a higher fraction of minute ventilation to participate in gas pulmonary exchanges. Moreover, it is able to guarantee the desired inhaled oxygen fraction (FiO2) even at high level of patient's minute ventilation by minimizing the room air entrainment. The effect of HFNC has never been investigated on stable severe COPD patients in term of endurance capacity with standardised laboratory tests. METHOD/DESIGN: We performed, in a randomized crossover study, two constant load exercise tests at the 75% of maximum workload achieved at a previous incremental exercise test on cycle-ergometer: with (HFNC-test) and without HFNC (Control-test). Both constant load tests were fulfilled at the same inhaled oxygen fraction (isoFiO2). RESULTS: The endurance time significantly increased in the HFNC-test compared to the Control-test (the mean difference between the two groups was 109 ± 104 s, p < 0.015). At iso-time, HFNC-test showed a better oxygen saturation (95 ± 3% vs 89 ± 3%, respectively, p < 0.005) either in the subgroup of patients who used supplemental oxygen and in the subgroup who did not. Moreover, a significantly lower dyspnea (median of 5.5 vs 10, respectively, p = 0.002) and leg fatigue score (median of 5 vs 9.5, p = 0.002) was recorded at iso-time during HFNC-test. CONCLUSION: HFNC may improve the exercise performance in severe COPD patients with ventilatory limitation. This effect is associated to an improvement of SaO2 and perceived symptoms at iso-time. In a Pulmonary Rehabilitation program HFNC may allow a given high intensity load to be sustained for a longer time with less symptoms. SN - 1532-3064 UR - https://www.unboundmedicine.com/medline/citation/27578482/Effects_of_heated_and_humidified_high_flow_gases_during_high_intensity_constant_load_exercise_on_severe_COPD_patients_with_ventilatory_limitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(16)30177-9 DB - PRIME DP - Unbound Medicine ER -