SESSION TITLE: Dyspnea in COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PM
PURPOSE: The NIOV respiratory assist device (Breathe Technologies, Inc) uses novel technology to generate nasal gas flow to augment ventilation. Using compressed air or oxygen, the NIOV uses specially designed loose fitting nasal prongs to generate augmented airflow using the Bernoulli principle. We sought to determine the effect of different NIOV settings on diaphragm function and breathing pattern.
METHODS: The NIOV device was connected to a 50 psi oxygen source and set at one of 3 different settings to provide more or less respiratory assistance administered in random fashion. Patients with severe COPD (GOLD stage 3 or 4) who were using accessory muscles at rest were offered enrollment. Consenting patients were studied sitting during the daytime. Tidal volume was measured using impedance plethysmography, oxygenation saturation and Ptc(transcutaneous)CO2 using a Sentec monitor, and esophageal, gastric and transdiaphragmatic pressures using manometry balloons. Continuous positive airway pressure (PAP) and Bilevel PAP (BPAP) were used for comparison.
RESULTS: Five patients have been studied thus far, with age 62 years, body mass index 24.7 m/kg2, FEV1 1.3L and FEV1% 32.8. Mean responses and SEMs are as follows (n = 5 for Breathe, n = 2 for CPAP, BiPAP): Mean values VT (mL) Esoph TDP ΔP RR PtcCO2 Baseline/mask 472±60 11.0±2.3 12.7±2.2 16.6±1.6 40.0±0.7 Breathe 100 488±125 10.2±2.4 14.5±2.4 15.2±1.9 38.7±1.4 Breathe 180 507±115 10.0±2.4 13.8±2.4 14.8±1.9 38.6±1.5 Breathe 250 587±141* 10.4±1.8 14.2±1.5 14.6±2.4 36.6±1.3* CPAP 4 557 9.3 12.1 17 39.2 BPAP 8/4 656 6.7 8.4 18 37.5 BPAP 12/4 840 4.4 9.4 11 36.3
CONCLUSIONS: The NIOV device significantly enhances tidal volume and lowers PtcCO2 in patients with severe COPD without significantly lowering esophageal or trans-diaphragmatic pressure, consistent with improved ventilatory efficiency. BPAP appears to achieve both of these effects and also lowers esophageal pressure swings.
CLINICAL IMPLICATIONS: The Breathe NIOV improves ventilator efficiency in patients with severe COPD and may be of use in alleviating dyspnea or enhancing exercise capacity.
DISCLOSURE: Rebecca Mabry: Employee: Breathe Technologies The following authors have nothing to disclose: Viola Tracy, Matthew Cohn, Aarti Grover, Nicholas Hill
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