Subject(s)
Hypercapnia , Hypoventilation/therapy , Noninvasive Ventilation , Respiratory Insufficiency/therapy , Acute Disease , Adult , Guidelines as Topic , Humans , Hypercapnia/etiology , Hypercapnia/therapy , Hypoventilation/etiology , Noninvasive Ventilation/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Risk Factors , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: High-intensity (high-pressure and high backup rate) noninvasive ventilation has recently been advocated for the management of stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the relative contributions of high inspiratory pressure and high backup rate to ventilator adherence and physiological outcome have not been investigated. METHODS: Patients with stable hypercapnic COPD (daytime PaCO(2) > 6 kPa) and nocturnal hypoventilation were enrolled. Patients were randomly allocated to high-pressure and high backup rate (high-intensity) and high-pressure and low backup rate (high-pressure) for a 6-week period. At the end of the first treatment period, patients were switched to the alternative treatment. The primary outcome measure was mean nightly ventilator usage. RESULTS: Twelve patients were recruited, with seven completing the 12-week trial protocol. The mean patient age was 71 ± 8 years, with a forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) of 50% ± 13% and FEV(1) of 32% ± 12%. The baseline PaCO(2) and PaO(2) were 8.6 ± 1.7 kPa and 7.3 ± 1.4 kPa, respectively. There was no significant difference demonstrated in mean nightly ventilator usage between the high-intensity and high-pressure groups (difference of 4 minutes; 95% confidence interval -45 to 53; P = 0.9). Furthermore, there were no differences in any of the secondary endpoints, with the exception of the respiratory domain of the Severe Respiratory Insufficiency questionnaire, which was lower in the high-intensity arm than in the high-pressure arm (57 ± 11 versus 69 ± 16; P < 0.05). CONCLUSION: There was no additional benefit, in terms of night-time ventilator adherence or any of the other measured parameters, demonstrated by addition of a high backup rate to high-pressure noninvasive ventilation. These data suggest that it is the high-pressure component of the high-intensity noninvasive ventilation approach that plays the important therapeutic role in the management of hypercapnic respiratory failure in COPD patients.
Subject(s)
Hypercapnia/therapy , Lung/physiopathology , Noninvasive Ventilation , Pulmonary Disease, Chronic Obstructive/therapy , Respiration, Artificial/methods , Aged , Aged, 80 and over , Cross-Over Studies , Female , Forced Expiratory Volume , Humans , Hypercapnia/diagnosis , Hypercapnia/physiopathology , London , Male , Middle Aged , Patient Compliance , Pressure , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality of Life , Single-Blind Method , Surveys and Questionnaires , Time Factors , Treatment Outcome , Vital CapacityABSTRACT
PURPOSE: To report physical, psychological and functional outcomes from a pilot study of a multi-disciplinary rehabilitation programme for post-polio syndrome (PPS). METHOD: Twenty-seven participants completed the nine-day programme and were available for re-assessment at three and six months. Physical outcome measures were muscle strength and endurance; psychological outcomes included illness perceptions (IPQ), depression and anxiety (HADS); functional outcomes were fatigue (HFS) and client-centred occupational performance and satisfaction (COPM). RESULTS: There was no significant change at six months for muscle strength or anxiety. Significant improvements were recorded for exercise endurance, depression and levels of fatigue. A shift towards an endorsement that the patient's own behaviour could be important in symptom severity of PPS was seen. Five out of 24 participants demonstrated significant clinical changes in occupational performance and satisfaction on the COPM. CONCLUSIONS: Prolonged benefits were found for physical, psychological and functional outcomes. A qualitative study is planned to investigate the patient-reported benefits of attending the programme such as the support gained interacting with others with similar disability and in lifestyle adjustment such as pacing of physical activities.
