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Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD

Authors Schaper-Magalhães F, Pinho JF, Capuruço CAB, Rodrigues-Machado MG

Received 4 April 2017

Accepted for publication 29 July 2017

Published 6 October 2017 Volume 2017:12 Pages 2943—2954

DOI https://doi.org/10.2147/COPD.S138737

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Flavia Schaper-Magalhães,1 José Felippe Pinho,1 Carolina Andrade Bragança Capuruço,2 Maria Glória Rodrigues-Machado1

1Medical Sciences Faculty of Minas Gerais, Post-Graduation Program in Health Sciences, Belo Horizonte, Brazil; 2Department of Cardiology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil

Background: Inspiratory muscle training (IMT) using a Threshold® device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown.
Objective: To assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD.
Methods: Twenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP.
Results: Patients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions.
Conclusion: Acute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.

Keywords:
echocardiography, mitral valve, tricuspid valve, inspiratory muscle strength, spirometry, Medical Research Council, dyspnea scale

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