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Noninvasive Mechanical Ventilation Improves Endurance Performance in Patients With Chronic Respiratory Failure Due to Thoracic Restriction^*

^* From the Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, D-57392 Schmallenberg-Grafschaft, Germany.

Correspondence to: Bernd Schonhofer, MD, PhD, Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, D-57392 Schmallenberg –Grafschaft, Germany; e-mail: Bernd.Schoenhofer{at}t-online.de

Objective: Treatment with noninvasive mechanical ventilation (NMV) alleviates hypoventilation and improves gas exchange in patients with chronic respiratory failure (CRF) due to thoracic restriction. However, little is known about the effects of NMV on respiratory and peripheral muscle endurance.

Design: Prospective case-control study.

Subjects: Ten patients in clinically stable condition (age, 53.5 ± 8.2 years [mean ± SD]) with mild-to-moderate CRF due to thoracic restriction (PCO₂ between 45 mm Hg and 55 mm Hg) were treated with NMV during the night for 3 months. Ten matched patients (age, 52.2 ± 9.5 years) receiving 3 months of normal care without NMV served as a control group.

Intervention and measurements: After a 3-day period of familiarization with the endurance tests, all patients performed a baseline preintervention inspiratory threshold loading test, cycle ergometer test, and shuttle walking test on the same day. The endurance tests were then repeated following the 3-month intervention period.

Results: NMV was used on average for 7.1 ± 0.9 h/d during the 3-month period. There was a significant improvement in endurance time (p < 0.0001) in all three endurance tests in the NMV group compared with the control group. In the NMV group, endurance time increased by 278 ± 269% during the inspiratory threshold loading test, by 176 ± 159% during the cycle ergometer test, and by 32 ± 22% during the shuttle walking test. Significant improvements (p < 0.01) in both PO₂ and PCO₂ were also observed in the NMV group but not in the control group.

Conclusions: Three months of treatment with NMV increases both respiratory and peripheral muscle endurance in patients with CRF due to thoracic restriction.

Key Words: chronic respiratory failure • cycle ergometer • inspiratory threshold loading • noninvasive mechanical ventilation • respiratory muscle endurance • shuttle walk

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