Background Chronic hypercapnic respiratory failure in obesity hypoventilation syndrome (OHS) is commonly treated with non-invasive ventilation (NIV). We hypothesised that treatment of OHS would improve neural respiratory drive (NRD) and improve cardiac function. Patients and methods A prospective, observational single-centre study was conducted. OHS patients were assessed recording NRD, as measured by the electromyogram of the parasternal intercostals (EMGpara) before, during and after NIV set-up and cardiac function with trans-thoracic echocardiography (TTE) before and after NIV set-up. Follow up appointments were planned at 6-weeks (6W-FU) and 3 Months (3M-FU). The tricuspid annular plane systolic excursion (TAPSE) score was used to assess the right ventricular (RV) function and EMGpara%max and neural respiratory drive index (NRDI) were recorded to assess NRD. The Wilcoxon test was used to compare baseline with follow-up results. Results 10 patients (age 55.9 (7.6) years, females 50%, weight 126.6 (29.1) kg, BMI 48.1 (7.5) kg/m2) were studied. 3 patients were non-compliant with NIV. NRDI and EMGpara%maxsignificantly improved following NIV set-up, and this effect was maintained at 3M-FU (EMGpara%max 24.4 (12.9)%, 16.9 (5.4)% and 18.6 (6.5)%, p = 0.028 and p = 0.035; NRDI 480.4 (256.0)/min, 314.7 (125.6)/min and 379.5 (138.0)/min, p = 0.22 and p = 0.012; Figure 1). There were no significant differences in cardiac function between baseline and 3M-FU (TAPSE: 2.6 (0.6) mm vs. 2.4 (0.4) mm, p = 1.00) or systolic pulmonary artery pressures (sPAP 36.7 (15.2) mmHg vs 35.8 (16.2) mmHg, p: 0.50). The TAPSE score in compliant patients seemed to improve (n = 3; 2.3 (0.6) mm vs. 2.7 (0.3) mm) while non compliant patients experienced a deterioration (n = 3; 2.7 (0.5) mm vs. 2.2 (0.4) mm). Conclusions NIV improves NRD and respiratory parameters in patients with OHS. However, cardiac function does not improve over a three-month period despite the significant improvements in ventilation. These results are influenced by treatment adherence.
Onofri, A., Patout, M., Arbane, G., Pengo, M., Marino, P., Steier, J. (2016). Neural respiratory drive and cardiac function in patients with obesity-hypoventilation-syndrome following setup of non-invasive ventilation for hypercapnic respiratory failure. THORAX, 71(S3), 33-34 [10.1136/thoraxjnl-2016-209333.62].
Neural respiratory drive and cardiac function in patients with obesity-hypoventilation-syndrome following setup of non-invasive ventilation for hypercapnic respiratory failure
Pengo M;
2016
Abstract
Background Chronic hypercapnic respiratory failure in obesity hypoventilation syndrome (OHS) is commonly treated with non-invasive ventilation (NIV). We hypothesised that treatment of OHS would improve neural respiratory drive (NRD) and improve cardiac function. Patients and methods A prospective, observational single-centre study was conducted. OHS patients were assessed recording NRD, as measured by the electromyogram of the parasternal intercostals (EMGpara) before, during and after NIV set-up and cardiac function with trans-thoracic echocardiography (TTE) before and after NIV set-up. Follow up appointments were planned at 6-weeks (6W-FU) and 3 Months (3M-FU). The tricuspid annular plane systolic excursion (TAPSE) score was used to assess the right ventricular (RV) function and EMGpara%max and neural respiratory drive index (NRDI) were recorded to assess NRD. The Wilcoxon test was used to compare baseline with follow-up results. Results 10 patients (age 55.9 (7.6) years, females 50%, weight 126.6 (29.1) kg, BMI 48.1 (7.5) kg/m2) were studied. 3 patients were non-compliant with NIV. NRDI and EMGpara%maxsignificantly improved following NIV set-up, and this effect was maintained at 3M-FU (EMGpara%max 24.4 (12.9)%, 16.9 (5.4)% and 18.6 (6.5)%, p = 0.028 and p = 0.035; NRDI 480.4 (256.0)/min, 314.7 (125.6)/min and 379.5 (138.0)/min, p = 0.22 and p = 0.012; Figure 1). There were no significant differences in cardiac function between baseline and 3M-FU (TAPSE: 2.6 (0.6) mm vs. 2.4 (0.4) mm, p = 1.00) or systolic pulmonary artery pressures (sPAP 36.7 (15.2) mmHg vs 35.8 (16.2) mmHg, p: 0.50). The TAPSE score in compliant patients seemed to improve (n = 3; 2.3 (0.6) mm vs. 2.7 (0.3) mm) while non compliant patients experienced a deterioration (n = 3; 2.7 (0.5) mm vs. 2.2 (0.4) mm). Conclusions NIV improves NRD and respiratory parameters in patients with OHS. However, cardiac function does not improve over a three-month period despite the significant improvements in ventilation. These results are influenced by treatment adherence.
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