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Can non-invasive ventilation modulate cerebral, respiratory, and peripheral muscle oxygenation during high-intensity exercise in patients with COPD-HF?
Goulart CDL, Caruso FR, de Araujo ASG, de Moura SCG, Catai AM, Agostoni P, Mendes RG, Arena R, Borghi-Silva A
Frontiers in Cardiovascular Medicine 2021 Jan 31;8(772650):Epub
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIM: To evaluate the effect of non-invasive positive pressure ventilation (NIPPV) on (1) metabolic, ventilatory, and hemodynamic responses; and (2) cerebral (Cox), respiratory, and peripheral oxygenation when compared with SHAM ventilation during the high-intensity exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF). METHODS AND RESULTS: On separate days, patients performed incremental cardiopulmonary exercise testing and two constant-work rate tests receiving NIPPV or controlled ventilation (SHAM) (the bilevel mode-Astral 150) in random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin (OxyHb plus Mb) and deoxyhemoglobin (DeoxyHb plus Mb) were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, The Netherlands). NIPPV associated with high-intensity exercise caused a significant increase in exercise tolerance, peak oxygen consumption (VO2 in mlO2/kg/min), minute ventilation peak (V/E in ml/min), peak peripheral oxygen saturation (SpO2, %), and lactate/tlim (mmol/s) when compared with SHAM ventilation. In cerebral, respiratory, and peripheral muscles, NIPPV resulted in a lower drop in OxyHb plus Mb (p < 0.05) and an improved deoxygenation response DeoxyHb plus Mb (p < 0.05) from the half of the test (60% of Tlim) when compared with SHAM ventilation. CONCLUSION: Non-invasive positive pressure ventilation during constant work-rate exercise led to providing the respiratory muscle unloading with greater oxygen supply to the peripheral muscles, reducing muscle fatigue, and sustaining longer exercise time in patients with COPD-HF.

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