The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation

Author(s)

Goulart, Ssia da Luz ; Caruso, Flavia Rossi ; de Araujo, Adriana S. Garcia ; Cristina Garcia de Moura, Silvia ; Catai, Aparecida Maria ; Batista dos Santos, Polliana ; Kabbach, Erika Z. ; Arena, Ross ; Mendes, Renata Goncalves ; Borghi-Silva, Audrey

• Document type: Journal article
• Source: Respiratory Care; v. 68, n. 3, p. 10-pg., 2023-03-01.

Abstract

BACKGROUND: We sought to assess whether noninvasive ventilation (NIV) as an adjunct with high-intensity exercise (HIEx) is more effective than exercise alone or exercise + sham on respi-ratory and peripheral oxygenation and vascular function in subjects with coexisting COPD and heart failure (HF). METHODS: On separate days, subjects performed incremental cardiopulmo-nary exercise testing and 3 constant load tests: HIEx, HIEx+NIV, and HIEx+sham (bi-level mode, Astral 150). Subjects were randomized with a 1:1 block allocation for the HIEx+NIV group and HIEx+sham group until the limit of tolerance (Tlim). Peripheral and respiratory oxy-genation were assessed by oxyhemoglobin (O2Hb) and deoxyhemoglobin (Hb) using near -infra-red spectroscopy in the respiratory and peripheral musculature. Vascular function was assessed by endothelial function using the flow-mediated vasodilation (FMD) method. RESULTS: There was a significant increase in FMD (mm), FMD (%), and shear stress in the HIEx+NIV group when compared to HIEx or HIEx+sham (P < .05). Less extraction of O2 (Hb) in the peripheral and respiratory muscles was observed in the HIEx+NIV group (P < .05). We also found correla-tions between peripheral muscle oxygenation (O2Hb) at the moment 80% of Tlim (r = 0.71, P = .009) and peak of Tlim (100%) (r = 0.76, P = .004) with absolute FMD (mm) immediately after HIEx+NIV. CONCLUSIONS: NIV as an adjunct to HIEx can acutely unload the respiratory musculature with better redistribution of available blood flow and beneficially modulate endo-thelial function. These results may influence the approach to cardiopulmonary rehabilitation inpatients with coexisting COPD-HF. (AU)

• FAPESP's process: 18/03233-0 - Study of cardiorespiratory interaction and the supply of peripheral and cerebral oxygen as modulators of exercise capacity during bilevel application in the coexistence of COPD-CHF
• Grantee: Cássia da Luz Goulart
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)