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Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study

BACKGROUND: Continuous positive airway pressure (CPAP) is a major treatment strategy for severe chronic obstructive pulmonary disease (COPD), especially with respiratory failure. However, it remains inconclusive whether CPAP affects respiratory mechanics and neural drive in stable COPD patients with...

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Autores principales: Wang, Kai, Liang, Zhen-Yu, Wang, Xi-Long, Li, Yun, Lu, Yi-Rong, Liu, Jun-Fang, Li, Jia-Hui, Xu, Li-Mei, Chen, Guo-Qiang, Chang, Ping, Cen, Zhong-Ran, Chen, Xin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139021/
https://www.ncbi.nlm.nih.gov/pubmed/32274128
http://dx.doi.org/10.21037/jtd.2019.12.120
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author Wang, Kai
Liang, Zhen-Yu
Wang, Xi-Long
Li, Yun
Lu, Yi-Rong
Liu, Jun-Fang
Li, Jia-Hui
Xu, Li-Mei
Chen, Guo-Qiang
Chang, Ping
Cen, Zhong-Ran
Chen, Xin
author_facet Wang, Kai
Liang, Zhen-Yu
Wang, Xi-Long
Li, Yun
Lu, Yi-Rong
Liu, Jun-Fang
Li, Jia-Hui
Xu, Li-Mei
Chen, Guo-Qiang
Chang, Ping
Cen, Zhong-Ran
Chen, Xin
author_sort Wang, Kai
collection PubMed
description BACKGROUND: Continuous positive airway pressure (CPAP) is a major treatment strategy for severe chronic obstructive pulmonary disease (COPD), especially with respiratory failure. However, it remains inconclusive whether CPAP affects respiratory mechanics and neural drive in stable COPD patients without respiratory failure. METHODS: Twenty-two COPD patients without respiratory failure received CPAP starting from 4 to 10 cmH(2)O in 1 cmH(2)O increments. Respiratory pattern, end expiatory lung volume (EELV), dynamic PEEPi (PEEPi(dyn)), airway resistance (Raw), pressure-time product of diaphragmatic pressure (PTPdi) and esophageal pressure (PTPeso), root mean square (RMS) of diaphragm electromyogram (EMGdi) and ratio of ventilation (Ve) to EMGdi (i.e., Ve/RMS) were measured before and at each level of continue positive airway pressure (CPAP). A subgroup analysis was performed between patients with and without inspiratory muscle weakness. RESULTS: Nineteen patients completed the treatment. The respiratory pattern improved significantly after CPAP. Raw, PTPdi, and Pdi decreased significantly. ΔEELV decreased at 4 cmH(2)O (P<0.05), but increased significantly at >8 cmH(2)O. PEEPi(dyn) decreased from 2.18±0.98 to 1.37±0.55 cmH(2)O. RMS increased while Ve/RMS improved significantly after CPAP (P<0.05). Besides, CPAP could significantly improve respiratory mechanics in patients with inspiratory muscle weakness. CONCLUSIONS: CPAP improves respiratory pattern, PEEPi, Raw, work of breathing and efficiency of neural drive in COPD patients without respiratory failure, but easily increases dynamic pulmonary hyperinflation. These effects on respiratory mechanics are significant in patients with inspiratory muscle weakness.
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spelling pubmed-71390212020-04-09 Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study Wang, Kai Liang, Zhen-Yu Wang, Xi-Long Li, Yun Lu, Yi-Rong Liu, Jun-Fang Li, Jia-Hui Xu, Li-Mei Chen, Guo-Qiang Chang, Ping Cen, Zhong-Ran Chen, Xin J Thorac Dis Original Article BACKGROUND: Continuous positive airway pressure (CPAP) is a major treatment strategy for severe chronic obstructive pulmonary disease (COPD), especially with respiratory failure. However, it remains inconclusive whether CPAP affects respiratory mechanics and neural drive in stable COPD patients without respiratory failure. METHODS: Twenty-two COPD patients without respiratory failure received CPAP starting from 4 to 10 cmH(2)O in 1 cmH(2)O increments. Respiratory pattern, end expiatory lung volume (EELV), dynamic PEEPi (PEEPi(dyn)), airway resistance (Raw), pressure-time product of diaphragmatic pressure (PTPdi) and esophageal pressure (PTPeso), root mean square (RMS) of diaphragm electromyogram (EMGdi) and ratio of ventilation (Ve) to EMGdi (i.e., Ve/RMS) were measured before and at each level of continue positive airway pressure (CPAP). A subgroup analysis was performed between patients with and without inspiratory muscle weakness. RESULTS: Nineteen patients completed the treatment. The respiratory pattern improved significantly after CPAP. Raw, PTPdi, and Pdi decreased significantly. ΔEELV decreased at 4 cmH(2)O (P<0.05), but increased significantly at >8 cmH(2)O. PEEPi(dyn) decreased from 2.18±0.98 to 1.37±0.55 cmH(2)O. RMS increased while Ve/RMS improved significantly after CPAP (P<0.05). Besides, CPAP could significantly improve respiratory mechanics in patients with inspiratory muscle weakness. CONCLUSIONS: CPAP improves respiratory pattern, PEEPi, Raw, work of breathing and efficiency of neural drive in COPD patients without respiratory failure, but easily increases dynamic pulmonary hyperinflation. These effects on respiratory mechanics are significant in patients with inspiratory muscle weakness. AME Publishing Company 2020-03 /pmc/articles/PMC7139021/ /pubmed/32274128 http://dx.doi.org/10.21037/jtd.2019.12.120 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Wang, Kai
Liang, Zhen-Yu
Wang, Xi-Long
Li, Yun
Lu, Yi-Rong
Liu, Jun-Fang
Li, Jia-Hui
Xu, Li-Mei
Chen, Guo-Qiang
Chang, Ping
Cen, Zhong-Ran
Chen, Xin
Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title_full Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title_fullStr Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title_full_unstemmed Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title_short Continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable COPD: an exploratory study
title_sort continuous positive airway pressure improves respiratory mechanics and efficiency of neural drive in stable copd: an exploratory study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139021/
https://www.ncbi.nlm.nih.gov/pubmed/32274128
http://dx.doi.org/10.21037/jtd.2019.12.120
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