Contrasting pressure-support ventilation and helium-oxygen during exercise in severe COPD.

Abstract

Helium-oxygen mixtures and pressure-support ventilation have been used to unload the respiratory muscles and increase exercise tolerance in COPD. Considering the different characteristics of these techniques, we hypothesized that helium-oxygen would be more effective in reducing exercise-induced dynamic hyperinflation than pressure-support. We also hypothesized that patients would experience greater increases in respiratory rate and minute ventilation with helium-oxygen than with pressure-support. The hypotheses were tested in ten patients with severe COPD (FEV(1) = 28 ± 3% predicted [mean ± SE]) during constant-load cycling (80% maximal workrate) while breathing 30% oxygen-alone, helium-oxygen, and pressure-support in randomized order. As hypothesized, helium-oxygen had greater impact on dynamic hyperinflation than did pressure-support (end-exercise; p = 0.03). For the most part of exercise, respiratory rate and minute ventilation were greater with helium-oxygen than with pressure-support (p ≤ 0.008). During the initial phases of exercise, helium-oxygen caused less rib-cage muscle recruitment than did pressure-support (p < 0.03), and after the start of exercise it caused greater reduction in inspiratory reserve volume (p ≤ 0.02). Despite these different responses, helium-oxygen and pressure-support caused similar increases in exercise duration (oxygen-alone: 6.9 ± 0.8 min; helium-oxygen: 10.7 ± 1.4 min; pressure-support: 11.2 ± 1.6 min; p = 0.003) and similar decreases in inspiratory effort (esophageal pressure-time product), respiratory drive, pulmonary resistance, dyspnea and leg effort (p < 0.03). In conclusion, helium-oxygen reduced exercise-induced dynamic hyperinflation by improving the relationship between hyperinflation and minute ventilation. In contrast, pressure-support reduced hyperinflation solely as a result of lowering ventilation. Helium-oxygen was more effective in reducing exercise-induced dynamic hyperinflation in severe COPD, and was associated with greater increases in respiratory rate and minute ventilation than pressure-support.

• Authors: Omar Hussain, Eileen G Collins, Nalan Adiguzel, W Edwin Langbein, Martin J Tobin, Franco Laghi
• Journal: Respiratory medicine (Respir Med) Vol. 105 Issue 3 Pg. 494-505 (Mar 2011) ISSN: 1532-3064 [Electronic] England
• PMID: 20851591 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Copyright © 2010 Elsevier Ltd. All rights reserved.

Chemical References

• Helium
• Oxygen

Topics

• Analysis of Variance
• Exercise Therapy (methods)
• Exercise Tolerance (drug effects, physiology)
• Female
• Helium (administration & dosage, pharmacology)
• Humans
• Lung Volume Measurements
• Male
• Middle Aged
• Oxygen (administration & dosage, pharmacology)
• Oxygen Inhalation Therapy (methods)
• Pulmonary Disease, Chronic Obstructive (physiopathology, rehabilitation)