Serena Cirio1, Manuela Piran1, Michele Vitacca2, Giancarlo Piaggi1, Piero Ceriana1, Matteo Prazzoli1, Mara Paneroni2, Annalisa Carlucci3. 1. Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy. 2. Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Mazzini 129, Lumezzane, Brescia, 25066, Italy. 3. Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Via Maugeri 10, Pavia, 27100, Italy. Electronic address: annalisa.carlucci@fsm.it.
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.
RCT Entities:
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 COPDpatients 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 COPDpatients 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: Sebastiano Mercadante; Antonello Giarratano; Andrea Cortegiani; Cesare Gregoretti Journal: Support Care Cancer Date: 2017-04-25 Impact factor: 3.603
Authors: Fabiano Di Marco; Giovanni Sotgiu; Pierachille Santus; Denis E O'Donnell; Kai-Michael Beeh; Simone Dore; Maria Adelaide Roggi; Lisa Giuliani; Francesco Blasi; Stefano Centanni Journal: Respir Res Date: 2018-01-24