Long-Term Effect of Noninvasive Ventilation on Diaphragm in Chronic Respiratory Failure

• Published in: International journal of chronic obstructive pulmonary disease Vol. 17; pp. 205 - 212
• Main Authors: Hernandez-Voth, Ana, Sayas Catalan, Javier, Corral Blanco, Marta, Alonso Moralejo, Rodrigo, Perez Gonzalez, Virginia, De Pablo Gafas, Alicia, Castaño Menendez, Alba, Juarros Monteagudo, Lourdes, Villena Garrido, Victoria
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2022; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Adaptation; Blood & organ donations; Care and treatment; Chronic obstructive pulmonary disease; Clinical medicine; copd; Diaphragm - diagnostic imaging; diaphragmatic ultrasound; Female; Gases; Humans; Hypercapnia - diagnosis; Hypercapnia - etiology; Hypercapnia - therapy; Informed consent; Lung diseases, Obstructive; Lung transplants; Male; Medical research; Medicine, Experimental; Middle Aged; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Original Research; Patients; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary function tests; Quality of Life; Questionnaires; Respiratory failure; Respiratory insufficiency; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Software; Ultrasonic imaging; Ventilators; Germany; Spain; United States > US; diaphragmatic ultrasound; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S339498

Home non-invasive ventilation (NIV) is recommended in patients with COPD and hypercapnic chronic respiratory failure (HCRF). The mechanism by it can improve alveolar ventilation during spontaneous breathing is not yet completely explained. Our aim is to evaluate the impact of on diaphragm muscle function in a series of patients with HCRF.
Observational, longitudinal, prospective study of a series of patients with very severe chronic obstruction to airflow treated with home high imntensity NIV (HINIV). Patients underwent a baseline and after 12 months assessment including adherence to treatment, quality of life, respiratory function tests and diaphragmatic ultrasound. SPSS v.26 software was used for statistical analysis.
We studied 30 patients, 63% male, the mean age was 60.8 (±6.4) years old. Patients had a severe obstructive ventilatory pattern [FEV1 21.8 (±6.1)%] and hypercapnia [pCO2 56.4 (±7.2) mmHg]. After 12 months of HINIV, we observed significant increases in FVC of 9.2% (p = 0.002), FEV1 of 3.5% (p = 0.04), MIP of 9.4% (p = 0.006), and 6-minute-walking test (6MWT) of 31.9 m (p = 0.001), as well as decreases in paCO2 of 12.5 mmHg (p = 0.001), HCO3 of 4.7 mmol/L (p = 0.001) and BODE index from 7 to 6. Diaphragmatic ultrasound demonstrated an increase in the thickening fraction of 14% (p = 0.002). Respiratory symptoms (p = 0.04), physical function (p = 0.03), and sleep (p = 0.04) also improved.
In patients with HCRF due to very severe chronic obstruction to airflow, long-term HINIV can improve respiratory performance by improving the function of the diaphragmatic musculature. Larger multicenter clinical trials are needed to confirm the results suggested in this study.