Functional Electrical Stimulation-A New Therapeutic Approach to Enhance Exercise Intensity in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Crossover Trial.

OBJECTIVE: To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). DESIGN: A randomized, single-blind, placebo-controlled crossover trial. SETTING: Pulmonary rehabilitation department. PARTICIPANTS: Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. INTERVENTION: Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. MAIN OUTCOME MEASURES: The primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. RESULTS: FES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9-64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05-2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. CONCLUSIONS: FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.

Reliability of respiratory pressure measurements in ventilated and non-ventilated patients in ICU: an observational study.

BACKGROUND: Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare maximum respiratory pressures measured through an intubation catheter with the same measurements using a standard mouthpiece in extubated patients. METHODS: A prospective observational study was carried out in adults who had been under ventilation for at least 24 h and for whom extubation was planned. Maximal respiratory pressure measurements were carried out before and 24 h following extubation. RESULTS: Ninety patients were included in the analyses (median age: 61.5 years, median SAPS2 score: 42.5 and median duration of ventilation: 7 days). Maximum respiratory pressures measured through the intubation catheter were as reliable as measurements through a standard mouthpiece (difference in maximal inspiratory pressure: mean bias = - 2.43 ± 14.43 cmH2O and difference in maximal expiratory pressure: mean bias = 1.54 ± 23.2 cmH2O). CONCLUSION: Maximum respiratory pressures measured through an intubation catheter were reliable and similar to standard measures. Clinical trial registration Retrospectively Registered in ClinicalTrials.gov (NCT02363231).

Effect of high-flow nasal therapy during acute aerobic exercise in patients with chronic obstructive pulmonary disease after exacerbation: protocol for a randomised, controlled, cross-over trial.

INTRODUCTION: Early pulmonary rehabilitation is recommended after a severe exacerbation of chronic obstructive pulmonary disease (COPD). However, this is difficult to implement, particularly for exercise training. High-flow nasal therapy (HFNT) may reduce the work of breathing and dyspnoea and may improve exercise tolerance. METHODS AND ANALYSIS: This is a single-centre, prospective, controlled, randomised, cross-over study. Eligible patients will have a diagnosis of COPD (postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio of <0.7). Two constant work rate exercise tests at 80% of the peak work rate will be carried out on two consecutive days with and without HFNT. The primary outcome will be the difference in endurance time between the two conditions. Secondary outcomes will be the change in muscle oxygenation during exercise, dyspnoea and muscle fatigue, respiratory muscle strength after exercise, respiratory rate, cardiac frequency, transcutaneous CO2 pressure and pulsed O2 saturation. Nineteen patients will be included. Data will be analysed as intention to treat by a blinded statistician. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethics Committees Nord-Ouest III, Caen, France (N° ID RCB: 2016-A01325-46). The study will begin in April 2017 for a duration of 2 years. The results of the trial will be presented at national and international meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03058081.