Background: It has been shown that upper limbs activity increases the respiratory workload in patients with chronic respiratory failure (CRF). The object of the present study was to investigate whether, in these patients: (i) noninvasive positive pressure ventilation (NPPV) could sustain the inspiratory muscles to meet the greater ventilatory demand during upper limbs activity with the arm elevation test (AE); (ii) proportional assist ventilation (PAV) might be superior to pressure support ventilation (PSV) during AE, because of its potential more adaptable response to sudden changes in the ventilatory pattern. Methods: The study was performed in the pulmonary function laboratory of the Pulmonary Division in Verona General Hospital, Verona, Italy. We studied 8 male patients with CRF due to chronic obstructive pulmonary disease (COPD). Each patient received 2 treatment in random order with a crossover design: spontaneous breathing (SB), SB with AE, either PSV or PAV without and with AE, SB without and with AE, either PSV or PAV without and with AE. We measured: lung function tests, lung mechanics, ventilatory pattern and diaphragmatic effort (pressure time product, PTPdi). Results: (i) AE increases minute ventilation (+14%) and PTPdi (+64%); (ii) ventilatory support, both with PSV and PAV unloads the diaphragm both at rest (PTPdi -77% and -54%, respectively) and during arm elevation (PTPdi -54% and -44%, respectively). Conclusions: PAV and PSV unloads the diaphragm in patients with CRF due to COPD both during SB and AE; PAV can be more efficient than PSV in assisting the diaphragm during AE in producing a greater level of minute ventilation for a similar rise in PTPdi compared to PSV. Noninvasive ventilatory support should be considered in rehabilitation programs for training of upper limbs activity.
- Chronic respiratory failure
- Noninvasive positive pressure ventilation
- Proportional assist ventilation
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine