1
|
Vitacca M, Paneroni M, Zampogna E, Visca D, Carlucci A, Cirio S, Banfi P, Pappacoda G, Trianni L, Brogneri A, Belli S, Paracchini E, Aliani M, Spinelli V, Gigliotti F, Lanini B, Lazzeri M, Clini EM, Malovini A, Ambrosino N. High-Flow Oxygen Therapy During Exercise Training in Patients With Chronic Obstructive Pulmonary Disease and Chronic Hypoxemia: A Multicenter Randomized Controlled Trial. Phys Ther 2020; 100:1249-1259. [PMID: 32329780 DOI: 10.1093/ptj/pzaa076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/25/2019] [Accepted: 02/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD). METHODS A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated. RESULTS Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = -18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively. CONCLUSION In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity. IMPACT STATEMENT The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance.
Collapse
Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4 - 27100 Pavia, Italy
| | - Mara Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Elisabetta Zampogna
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Varese, Italy
| | - Dina Visca
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Varese, Italy
| | - Annalisa Carlucci
- Respiratory Rehabilitation of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Serena Cirio
- Respiratory Rehabilitation of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Paolo Banfi
- Respiratory Rehabilitation of the Institute of Milano, IRCCS Fondazione Don Gnocchi, Milano, Italy
| | - Gabriele Pappacoda
- Respiratory Rehabilitation of the Institute of Milano, IRCCS Fondazione Don Gnocchi, Milano, Italy
| | - Ludovico Trianni
- Respiratory Rehabilitation of Villa Pineta, Pavullo nel Frignano, Modena, Italy
| | - Antonio Brogneri
- Respiratory Rehabilitation of Villa Pineta, Pavullo nel Frignano, Modena, Italy
| | - Stefano Belli
- Respiratory Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Elena Paracchini
- Respiratory Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - Maria Aliani
- Respiratory Rehabilitation of the Institute of Cassano delle Murge, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy
| | - Vito Spinelli
- Respiratory Rehabilitation of the Institute of Cassano delle Murge, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy
| | - Francesco Gigliotti
- Respiratory Rehabilitation of the Institute of Firenze, IRCCS Fondazione Don Gnocchi, Firenze, Italy
| | - Barbara Lanini
- Respiratory Rehabilitation of the Institute of Firenze, IRCCS Fondazione Don Gnocchi, Firenze, Italy
| | | | - Enrico M Clini
- Department of Medical and Surgical Sciences, Università degli Studi Modena e Reggio Emilia, Modena, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Nicolino Ambrosino
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Pavia, Italy
| | | |
Collapse
|
2
|
Costi S, Crisafulli E, Trianni L, Beghè B, Faverzani S, Scopelliti G, Chetta A, Clini E. Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients. Int J Chron Obstruct Pulmon Dis 2019; 14:3017-3023. [PMID: 31920298 PMCID: PMC6938185 DOI: 10.2147/copd.s223038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results Compared to the category of individuals with 6MWD >350 meters, those patients with 201-350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.
Collapse
Affiliation(s)
- Stefania Costi
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplants Oncology and Regenerative Medicine-University of Modena and Reggio Emilia and Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Ludovico Trianni
- Rehabilitation Unit-Hospital Villa Pineta, Pavullo Nel Frignano, Modena, Italy
| | - Bianca Beghè
- Department of Medical and Surgical Sciences-University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Silvia Faverzani
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Giuseppe Scopelliti
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences-University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| |
Collapse
|
4
|
Clini EM, Siddu P, Trianni L, Graziosi R, Crisafulli E, Nobile MT. Activity and analysis of costs in a dedicated weaning centre. Monaldi Arch Chest Dis 2008; 69:55-8. [PMID: 18837417 DOI: 10.4081/monaldi.2008.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To analyse the diagnosis-related characteristics and the costs of treating patients with difficult/prolonged weaning from mechanical ventilation we have undertaken a retrospective observational study. METHODS The study has considered all the patients admitted to our weaning unit of a regional Rehabilitation department during 3 consecutive periods since the opening date. Characteristics of the admitted patients and the DRG-related cares delivered have been recorded. A cost analysis has been obtained over time. RESULTS The number of beds allocated to this unit (from 4 in the 1st period to 6 in the 2nd and 3rd periods) and the number of patients cared for (from 32 to 43 and to 65, respectively) increased over time. In particular, the COPD to non-COPD patient ratio (from 2.2 to 1.3 and to 1.0) and the DRG/patient weight (from 3.0 +/- 0.3 to 3.1 +/- 0.2 and to 3.3 +/- 0.2 point) changed significantly (p < 0.05). The daily reimbursement per patient from the public health care system only slightly increased, whereas the operating margin (reimbursement less costs) per patient significantly improved (from -304, to +17 and +55 Euro/pt/day, respectively, p < 0.05) due to a gradual restriction in the variable costs. Length of stay, mortality rate and weaning rate did not change over time. CONCLUSION The weaning centre is a hospital area where economic burdens should be carefully evaluated. Given the actual reimbursement received on a national level for these patients, variable costs might be better spread, thus optimising the burdens without losing out on clinical outcomes.
Collapse
Affiliation(s)
- E M Clini
- Institute of Respiratory Diseases, University of Modena-Reggio Emilia, Pavullo, MO, Italy.
| | | | | | | | | | | |
Collapse
|
5
|
Clini EM, Antoni FD, Vitacca M, Crisafulli E, Paneroni M, Chezzi-Silva S, Moretti M, Trianni L, Fabbri LM. Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial. Intensive Care Med 2006; 32:1994-2001. [PMID: 17061020 DOI: 10.1007/s00134-006-0427-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 09/19/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients. DESIGN AND SETTING Randomized multicenter trial in two weaning centers in northern Italy. PATIENTS AND PARTICIPANTS 46 tracheostomized patients (age 70 +/- 7 years, 28 men, arterial blood pH 7.436 +/- 0.06, PaO(2)/FIO(2) 238 +/- 46) weaned from mechanical ventilation. INTERVENTIONS Patients were assigned to two treatment groups performing chest physiotherapy (control), or percussive ventilation (IMP2 Breas, Sweden) 10 min twice/day in addition to chest physiotherapy (intervention). MEASUREMENTS AND RESULTS Arterial blood gases, PaO(2)/FIO(2) ratio, and maximal expiratory pressure were assessed every 5th day for 15 day. Treatment complications that showed up in 1 month of follow-up were recorded. At 15 days the intervention group had a significantly better PaO(2)/FIO(2) ratio and higher maximal expiratory pressure; after follow-up this group also had a lower incidence of pneumonia. CONCLUSIONS The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia.
Collapse
Affiliation(s)
- Enrico M Clini
- Department of Pulmonary Rehabilitation, University of Modena, and Ospedale Villa Pineta, Via Gaiato 127, Pavullo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|