Physiological changes during low- and high-intensity noninvasive ventilation

J. Lukácsovits, A. Carlucci, N. Hill, P. Ceriana, L. Pisani, A. Schreiber, P. Pierucci, G. Losonczy, S. Nava

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright

Original languageEnglish
Pages (from-to)869-875
Number of pages7
JournalEuropean Respiratory Journal
Volume39
Issue number4
DOIs
Publication statusPublished - Apr 1 2012

Fingerprint

Noninvasive Ventilation
Positive-Pressure Respiration
Respiration
Pressure
Respiratory Rate
Cardiac Output
Gases
Preexisting Condition Coverage
Diaphragm
Carbon Dioxide
Netherlands
Cross-Over Studies
Ventilation
Heart Diseases

Keywords

  • Chronic obstructive pulmonary disease
  • Noninvasive ventilation
  • Respiratory mechanics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lukácsovits, J., Carlucci, A., Hill, N., Ceriana, P., Pisani, L., Schreiber, A., ... Nava, S. (2012). Physiological changes during low- and high-intensity noninvasive ventilation. European Respiratory Journal, 39(4), 869-875. https://doi.org/10.1183/09031936.00056111

Physiological changes during low- and high-intensity noninvasive ventilation. / Lukácsovits, J.; Carlucci, A.; Hill, N.; Ceriana, P.; Pisani, L.; Schreiber, A.; Pierucci, P.; Losonczy, G.; Nava, S.

In: European Respiratory Journal, Vol. 39, No. 4, 01.04.2012, p. 869-875.

Research output: Contribution to journalArticle

Lukácsovits, J, Carlucci, A, Hill, N, Ceriana, P, Pisani, L, Schreiber, A, Pierucci, P, Losonczy, G & Nava, S 2012, 'Physiological changes during low- and high-intensity noninvasive ventilation', European Respiratory Journal, vol. 39, no. 4, pp. 869-875. https://doi.org/10.1183/09031936.00056111
Lukácsovits J, Carlucci A, Hill N, Ceriana P, Pisani L, Schreiber A et al. Physiological changes during low- and high-intensity noninvasive ventilation. European Respiratory Journal. 2012 Apr 1;39(4):869-875. https://doi.org/10.1183/09031936.00056111
Lukácsovits, J. ; Carlucci, A. ; Hill, N. ; Ceriana, P. ; Pisani, L. ; Schreiber, A. ; Pierucci, P. ; Losonczy, G. ; Nava, S. / Physiological changes during low- and high-intensity noninvasive ventilation. In: European Respiratory Journal. 2012 ; Vol. 39, No. 4. pp. 869-875.
@article{261e465144f44a89b946c05b01518a7e,
title = "Physiological changes during low- and high-intensity noninvasive ventilation",
abstract = "In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright",
keywords = "Chronic obstructive pulmonary disease, Noninvasive ventilation, Respiratory mechanics",
author = "J. Luk{\'a}csovits and A. Carlucci and N. Hill and P. Ceriana and L. Pisani and A. Schreiber and P. Pierucci and G. Losonczy and S. Nava",
year = "2012",
month = "4",
day = "1",
doi = "10.1183/09031936.00056111",
language = "English",
volume = "39",
pages = "869--875",
journal = "European Respiratory Journal",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "4",

}

TY - JOUR

T1 - Physiological changes during low- and high-intensity noninvasive ventilation

AU - Lukácsovits, J.

AU - Carlucci, A.

AU - Hill, N.

AU - Ceriana, P.

AU - Pisani, L.

AU - Schreiber, A.

AU - Pierucci, P.

AU - Losonczy, G.

AU - Nava, S.

PY - 2012/4/1

Y1 - 2012/4/1

N2 - In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright

AB - In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright

KW - Chronic obstructive pulmonary disease

KW - Noninvasive ventilation

KW - Respiratory mechanics

UR - http://www.scopus.com/inward/record.url?scp=84860330525&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860330525&partnerID=8YFLogxK

U2 - 10.1183/09031936.00056111

DO - 10.1183/09031936.00056111

M3 - Article

C2 - 21885393

AN - SCOPUS:84860330525

VL - 39

SP - 869

EP - 875

JO - European Respiratory Journal

JF - European Respiratory Journal

SN - 0903-1936

IS - 4

ER -