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Title: Influence of respiratory pressure support on hemodynamics and exercise tolerance in patients with COPD
Authors: Oliveira, Cristino Carneiro [UNIFESP]
Carrascosa, Claudia Regina [UNIFESP]
Borghi-Silva, Audrey [UNIFESP]
Berton, Danilo C. [UNIFESP]
Queiroga, Fernando [UNIFESP]
Ferreira, Eloara M. V. [UNIFESP]
Nery, Luiz E. [UNIFESP]
Neder, J. Alberto [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Universidade Federal de São Carlos (UFSCar)
Keywords: COPD
Inspiratory pressure support
Issue Date: 1-Jul-2010
Publisher: Springer
Citation: European Journal of Applied Physiology. New York: Springer, v. 109, n. 4, p. 681-689, 2010.
Abstract: Inspiratory pressure support (IPS) plus positive end-expiratory pressure (PEEP) ventilation might potentially interfere with the central hemodynamic adjustments to exercise in patients with chronic obstructive pulmonary disease (COPD). Twenty-one non- or mildly-hypoxemic males (FEV(1) = 40.1 +/- A 10.7% predicted) were randomly assigned to IPS (16 cmH(2)O) + PEEP (5 cmH(2)O) or spontaneous ventilation during constant-work rate (70-80% peak) exercise tests to the limit of tolerance (T (lim)). Heart rate (HR), stroke volume (SV), and cardiac output (CO) were monitored by transthoracic cardioimpedance (Physioflow (TM), Manatec, France). Oxyhemoglobin saturation was assessed by pulse oximetry (SpO(2)). At similar SpO(2), IPS(16) + PEEP(5) was associated with heterogeneous cardiovascular effects compared with the control trial. Therefore, 11 patients (Group A) showed stable or increased Delta isotime - rest SV [5 (0-29) mL], lower Delta HR but similar Delta CO. On the other hand, Delta SV [-10 (-15 to -3) mL] and Delta HR were both lower with IPS(16) + PEEP(5) in Group B (N = 10), thereby reducing Delta CO (p < 0.05). Group B showed higher resting lung volumes, and T (lim) improved with IPS(16) + PEEP(5) only in Group A [51 (-60 to 486) vs. 115 (-210 to 909) s, respectively; p < 0.05]. We conclude that IPS(16) + PEEP(5) may improve SV and exercise tolerance in selected patients with advanced COPD. Impaired SV and CO responses, associated with a lack of enhancement in exercise capacity, were found in a sub-group of patients who were particularly hyperinflated at rest.
ISSN: 1439-6319
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