Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients

Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD). Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). The present study is designed to investigate the benefits of a short outpatient program of IMT on inspiratory muscle performance, exercise capacity, perception of dyspnea, and the inspiratory fraction (IF). Thirty patients (24 males, 6 females) with significant COPD (forced expiratory volume in one second [FEV1] = 46.21% ± 6.7% predicted, FEV1 = 33.6% ± 8.04% predicted) were recruited for this study and had 3 months of IMT (30 minutes/day for 6 days/week) in an outpatient clinic. Following IMT, there was a statistically significant increase in inspiratory muscle performance (an increase of the maximal inspiratory pressure from 59% ± 19.1% to 79% ± 21.85% predicted; p = 0.0342), a decrease in dyspnea (from 5.8 ± 0.78 to 1.9 ± 0.57; p = 0.0001), an increase in the distance walked during the 6 minute walk test, from 245 ± 52.37 m to 302 ± 41.30 m, and finally an increase in the IF (the new prognostic factor in COPD) from 27.6 ± 9.7% to 31.4% ± 9.8%. The present study concludes that in patients with significant COPD, IMT results in improvement in performance, exercise capacity, sensation of dyspnea, and moreover an improvement in the IF prognostic factor

Réhabilitation respiratoire chez les patients atteints de BPCO

Ce travail réalisé au sein du Service d Exploration Fonctionnelle Respiratoire (Hôpital de la Croix-Rousse) évalue la prise en charge de patients souffrant de broncho-pneumopathie obstructive chronique (BPCO) dans le cadre d une réadaptation fonctionnelle. Nous avons évalué d abord les effets d un programme de réhabilitation réalisé sur 80 patients (VEMS à 46%) pendant 14 semaines dans le Service en ambulatoire à raison de 3 fois par semaine. Le bénéfice est significatif sur le test de marche, le questionnaire de qualité de vie et l index de BODE. Pendant ce programme, nous avons également évalué sur 30 patients les effets d un entraînement spécifique des muscles ventilatoires avec augmentation significative de la pression maximale inspiratoire à l issue de ces séances. Un groupe plus restreint de patients (12 patients :VEMS à 34 %) a bénéficié pendant le réentraînement de l apport d une ventilation non invasive (VNI) afin de leur permettre d accomplir la totalité du programme de réentraînement. La suite de la réhabilitation à domicile est également très importante. Notre dernière étude a évalué les effets d'un programme de réhabilitation à domicile sur une période de 1 à 5 ans avec poursuite de l amélioration des acquis du réentraînement effectué au préalable dans le Service EFRThis work was completed within the Service of Respiratory Functional Exploration (Hospital of Croix-Rousse- Lyon- France) evaluates patients suffering from chronic obstructive pulmonary disease (COPD) by using pulmonary rehabilitation. We initially evaluated the effects of an entirely outpatient-based program of pulmonary rehabilitation carried out on 80 patients (FEV1 = 46%) in which 40 exercise sessions were held two to three times per week for about 14 weeks. The benefit is significant on the 6-minutes walking test (6-MWT), the questionnaire of quality of life (SGRQ) and BODE index. During this program, we also evaluated on 30 patients the effects of a specific training program of ventilatory muscles with significant increase of the maximum inspiratory pressure at the end of this program. The continuation of the rehabilitation at home is also very important. One of our studies evaluated the effects of a programme of pulmonary rehabilitation at home over a period from 1 to 5 years with continuation of the improvement which they won during the first program of outpatient pulmonary rehabilitation. Finally, A group of patients with severe COPD (12 patients: FEV1= 34%) assisted during their outpatient pulmonary rehabilitation by non invasive ventilatory support (NIVS) which was delivered using AI vision in PAV mode of the ventilator VS Ultra in order to enabling them to achieve the totality of their program of rehabilitationLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Pulmonary gas exchange during hemodialysis

Pulmonary gas exchange during hemodialysis. Pulmonary gas exchange was continuously measured in 13 mechanically ventilated patients during 24 hemodialyses for acute renal failure. Minute–ventilation was maintained constant by controlled ventilation and gas exchange was continuously measured by a mass–spectrometer system. Three groups were compared: 1) a cuprophan membrane with an acetate dialysate; 2) a polyacrilonitrile membrane (PAN) with an acetate dialysate; and 3) PAN with a bicarbonate dialysate. Arterial PO2 and the O2 alveolar–arterial gradient were the same regardless of the membrane used. [H+] mildly decreased with all dialysates used. Arterial PCO2decreased only with the acetate dialysate. O2 consumption increased, up to 20 ± 5% of the initial values during hemodialysis, and remained increased during the two hours following the hemodialysis. Respiratory exchange ratio was lower after than before the hemodialysis. In conclusion: 1) the maintenance of a constant minute ventilation prevented hemodialysis induced hypoxemia. 2) VO2 increased during hemodialysis

Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs

To evaluate the effect of increased intra-abdominal pressure (IAP) on the systolic and pulse pressure variations induced by positive pressure ventilation in a porcine model