AUTHOR=Goulart Cássia da Luz , Caruso Flávia Rossi , de Araújo Adriana Sanches Garcia , Moura Sílvia Cristina Garcia de , Catai Aparecida Maria , Agostoni Piergiuseppe , Mendes Renata Gonçalves , Arena Ross , Borghi-Silva Audrey 

TITLE=Can Non-invasive Ventilation Modulate Cerebral, Respiratory, and Peripheral Muscle Oxygenation During High-Intensity Exercise in Patients With COPD-HF?

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.772650

DOI=10.3389/fcvm.2021.772650

ISSN=2297-055X

ABSTRACT=<sec><title>Aim</title><p>To evaluate the effect of non-invasive positive pressure ventilation (NIPPV) on (1) metabolic, ventilatory, and hemodynamic responses; and (2) cerebral (Cox), respiratory, and peripheral oxygenation when compared with SHAM ventilation during the high-intensity exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).</p></sec><sec><title>Methods and Results</title><p>On separate days, patients performed incremental cardiopulmonary exercise testing and two constant-work rate tests receiving NIPPV or controlled ventilation (SHAM) (the bilevel mode—Astral 150) in random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin (OxyHb+Mb) and deoxyhemoglobin (DeoxyHb+Mb) were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, The Netherlands). NIPPV associated with high-intensity exercise caused a significant increase in exercise tolerance, peak oxygen consumption (<inline-formula><mml:math id="M1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>V</mml:mi><mml:mo>·</mml:mo></mml:mover><mml:msub><mml:mtext>O</mml:mtext><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math></inline-formula> in mlO<sub>2</sub>·kg<sup>−1</sup>·min<sup>−1</sup>), minute ventilation peak (<inline-formula><mml:math id="M2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:msub><mml:mrow><mml:mover><mml:mi>V</mml:mi><mml:mo>·</mml:mo></mml:mover></mml:mrow><mml:mtext>E</mml:mtext></mml:msub></mml:mrow></mml:math></inline-formula> in ml/min), peak peripheral oxygen saturation (SpO<sub>2</sub>, %), and lactate/tlim (mmol/s) when compared with SHAM ventilation. In cerebral, respiratory, and peripheral muscles, NIPPV resulted in a lower drop in OxyHb+Mb (<italic>p</italic> &lt; 0.05) and an improved deoxygenation response DeoxyHb+Mb (<italic>p</italic> &lt; 0.05) from the half of the test (60% of Tlim) when compared with SHAM ventilation.</p></sec><sec><title>Conclusion</title><p>Non-invasive positive pressure ventilation during constant work-rate exercise led to providing the respiratory muscle unloading with greater oxygen supply to the peripheral muscles, reducing muscle fatigue, and sustaining longer exercise time in patients with COPD-HF.</p></sec>