Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, United States of America.
Respir Med. 2021 May;181:106389. doi: 10.1016/j.rmed.2021.106389. Epub 2021 Apr 2.
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with an elevated risk of cardiovascular events, which can be linked to endothelial dysfunction. In this study, we aimed to investigate whether noninvasive ventilation (NIV) acutely changes endothelial function in hospitalized AECOPD patients.
Twenty-one AECOPD patients were assessed in a hospital ward setting from 24 to 48 h after admission. NIV was applied using a ventilator with bilevel pressure support. Before and after NIV protocol, patients were evaluated regarding (1) endothelium-dependent function, assessed non-invasively using the flow-mediated dilation (FMD) method; (2) arterial blood gas analysis. Other baseline evaluations included clinical and anthropometric data, and laboratory tests.
The total group showed a significant improvement in FMD as a result of NIV effect (P = 0.010). While arterial carbon dioxide and oxygen were not altered, oxygen saturation increased after NIV (P = 0.045). The subgroup comparison of responders (FMD ≥ 1%) and non-responders (FMD < 1%) showed significant baseline differences in body mass index (BMI) (P = 0.019) and predicted forced expiratory volume in one second (FEV) (P = 0.007). In univariate and multivariate analyses, both BMI and FEV were determinant for endothelial response to NIV.
NIV acutely improves endothelial function in hospitalized AECOPD patients. Overweight and COPD severity may represent important characteristics for the magnitude of peripheral vascular response.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）与心血管事件风险升高相关，这可能与内皮功能障碍有关。在本研究中，我们旨在研究住院 AECOPD 患者中，无创通气（NIV）是否能急性改变内皮功能。
在入院后 24-48 小时，我们在医院病房环境中评估了 21 名 AECOPD 患者。使用具有双水平压力支持的呼吸机进行 NIV。在 NIV 方案前后，我们评估了患者以下情况：（1）内皮依赖性功能，使用血流介导的舒张（FMD）方法进行无创评估；（2）动脉血气分析。其他基线评估包括临床和人体测量数据以及实验室检查。
总体而言，NIV 作用导致 FMD 显著改善（P=0.010）。虽然动脉二氧化碳和氧气没有改变，但 NIV 后氧饱和度增加（P=0.045）。应答者（FMD≥1%）和无应答者（FMD<1%）的亚组比较显示，体重指数（BMI）（P=0.019）和预测的 1 秒用力呼气量（FEV）（P=0.007）存在显著的基线差异。在单变量和多变量分析中，BMI 和 FEV 都是内皮对 NIV 反应的决定因素。
NIV 可急性改善住院 AECOPD 患者的内皮功能。超重和 COPD 严重程度可能代表外周血管反应幅度的重要特征。
