Effects of noninvasive ventilation with bilevel positive airway pressure on exercise tolerance and dyspnea in heart failure patients.

BACKGROUND: Heart failure (HF) is a syndrome that results in inadequate blood supply, leading to a number of structural and functional changes. Noninvasive ventilatory support (NIVS) is used as an adjuvant treatment to improve the functional capacity of these patients. OBJECTIVE: To investigate the effect of NIVS with bilevel positive airway pressure ventilation (BiPAP) on exercise tolerance and dyspnea in HF patients. METHODS: Forty patients with New York Heart Association class I/II/III HF were randomly assigned either to a NIVS group (n = 20) or control group (n = 20). All patients underwent two 6-min walk tests (6MWT), with a 30-min interval between them. In the NIVS group, the patients performed the BiPAP with an inspiratory positive airway pressure of 12 cmH2O and expiratory positive airway pressure of 6 cmH2O for 30 min. At baseline, and after the first and second 6MWT, the heart rate, systolic and diastolic blood pressure, peripheral oxygen saturation (SaO2), and dyspnea were evaluated. RESULTS: Forty patients completed the study safely according to the randomization protocol, and no adverse events were reported during the tests. The NIVS group showed a significant improvement in the 6MWT distance (68.3 vs. 9.8 m) and dyspnea (1.3 vs. 3.1) compared with the control group. No serious adverse events were reported. CONCLUSIONS: NIVS/BiPAP showed beneficial effects on exercise tolerance and dyspnea. It was safe and well tolerated by HF patients and should be considered for inclusion in cardiac rehabilitation programs.

Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward.

BACKGROUND: Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. METHODS: This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge. RESULTS: The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change. CONCLUSION: The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.