Ventilatory assistance improves exercise endurance in stable congestive heart failure

被引:92
作者
O'Donnell, DE [1 ]
D'Arsigny, C [1 ]
Raj, S [1 ]
Abdollah, H [1 ]
Webb, KA [1 ]
机构
[1] Queens Univ, Dept Med, Resp Investigat Unit, Kingston, ON K7L 3N6, Canada
关键词
D O I
10.1164/ajrccm.160.6.9808134
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
We postulated that ventilatory assistance during exercise would improve cardiopulmonary function, relieve exertional symptoms, and increase exercise endurance (T-lim) in patients with chronic congestive heart failure (CHF). After baseline pulmonary function tests, 12 stable patients with advanced CHF (ejection fraction, 24 +/- 3% [mean +/- SEM]) performed constant-load exercise tests at approximately 60% of their predicted maximal oxygen consumption ((V)over dot o(2)max) while breathing each of control (1 cm H2O), continuous positive airway pressure optimized to the maximal tolerable level (CPAP = 4.8 +/- 0.2 cm H2O) or inspiratory pressure support (PS = 4.8 +/- 0.2 cm H2O), in randomized order. Measurements during exercise included cardioventilatory responses, esophageal pressure (Pes), and Borg ratings of dyspnea and leg discomfort (LD). At a standardized time near end-exercise, PS and CPAP reduced the work of breathing per minute by 39 +/- 8 and 25 +/- 4%, respectively (p < 0.01). In response to PS: T-lim increased by 2.8 +/- 0.8 min or 43 +/- 14% (p < 0.01); slopes of LD-time, (V)over dot o(2)-time, (V)over dot co(2)-time, and tidal Pes-time decreased by 24 +/- 10, 20 +/- 11, 28 +/- 8, and 44 +/- 9%, respectively (p < 0.05); dyspnea and other cardioventilatory parameters did not change. CPAP did not significantly alter measured exercise responses. The increase in Tli, was explained primarily by the decrease in LD-time slopes (r = -0.71, p < 0.001) which, in turn, correlated with the reductions in (V)over dot o(2)-time (r = 0.61, p < 0.01) and tidal Pes-time (r = 0.52, p < 0.01). in conclusion, ventilatory muscle unloading with PS reduced exertional leg discomfort and increased exercise endurance in patients with stable advanced CHF.
引用
收藏
页码:1804 / 1811
页数:8
相关论文
共 35 条
[2]  
BAYDUR A, 1982, AM REV RESPIR DIS, V126, P788
[3]   A NEW METHOD FOR DETECTING ANAEROBIC THRESHOLD BY GAS-EXCHANGE [J].
BEAVER, WL ;
WASSERMAN, K ;
WHIPP, BJ .
JOURNAL OF APPLIED PHYSIOLOGY, 1986, 60 (06) :2020-2027
[4]   EFFECT OF PRESSURE AND TIMING OF CONTRACTION ON HUMAN DIAPHRAGM FATIGUE [J].
BELLEMARE, F ;
GRASSINO, A .
JOURNAL OF APPLIED PHYSIOLOGY, 1982, 53 (05) :1190-1195
[5]   PSYCHOPHYSICAL BASES OF PERCEIVED EXERTION [J].
BORG, GAV .
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, 1982, 14 (05) :377-381
[6]   CARDIAC-OUTPUT RESPONSE TO CONTINUOUS POSITIVE AIRWAY PRESSURE IN CONGESTIVE-HEART-FAILURE [J].
BRADLEY, TD ;
HOLLOWAY, RM ;
MCLAUGHLIN, PR ;
ROSS, BL ;
WALTERS, J ;
LIU, PP .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 145 (02) :377-382
[7]   RELATIONSHIP BETWEEN AIRWAY RESISTANCE, AIRWAY CONDUCTANCE AND LUNG VOLUME IN SUBJECTS OF DIFFERENT AGE AND BODY SIZE [J].
BRISCOE, WA ;
DUBOIS, AB .
JOURNAL OF CLINICAL INVESTIGATION, 1958, 37 (09) :1279-1285
[8]  
BULLER NP, 1990, BRIT HEART J, V63, P281
[9]   The intrapleural pressure in congestive heart failure and its clinical significance [J].
Christie, RV ;
Meakins, JC .
JOURNAL OF CLINICAL INVESTIGATION, 1934, 13 (02) :323-345
[10]   MUSCLE FATIGUE AND DYSPNEA IN CHRONIC HEART-FAILURE - 2 SIDES OF THE SAME COIN [J].
CLARK, AL ;
SPARROW, JL ;
COATS, AJS .
EUROPEAN HEART JOURNAL, 1995, 16 (01) :49-52