Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.
Pompeu Fabra University (UPF), Barcelona, Spain.
BMC Pulm Med. 2021 Nov 8;21(1):355. doi: 10.1186/s12890-021-01727-9.
Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT.
This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO) and respiratory and leg symptoms.
Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DL were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices.
This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.
标准氧疗（SOT）补充的氧气可提高特发性肺纤维化（IPF）患者的运动能力。虽然高流量鼻导管氧疗（HFNC）可改善其他呼吸系统疾病的氧合，但从未在 IPF 患者中评估其对运动表现的影响。我们假设 HFNC 可能比 SOT 更能改善 IPF 患者的运动能力。
这是一项前瞻性、交叉、随机对照的试验，比较了 IPF 患者在 6 分钟步行试验中运动时血氧饱和度（SpO2）≤85%时，两种氧疗方法在恒定次最大心肺运动试验（CPET）中的氧合作用。主要结局是耐力时间（Tlim）。次要结局是肌肉氧饱和度（StO）和呼吸及腿部症状。
共纳入 10 名 IPF 患者[71.7（6）岁，90%为男性]。FVC 和 DL 分别为 58±11%和 31±13%预计值。CPET 期间使用 HFNC 的 Tlim 明显长于 SOT[494±173 与 381±137 s，p=0.01]。HFNC 还与吸气量（IC）的显著增加相关[19.4±14.2 与 7.1±8.9%，分别；p=0.04]，运动期间的 StO 也有类似的趋势。两种氧气设备之间在呼吸或腿部症状方面没有差异。
这是第一项研究表明，HFNC 氧疗在运动性低氧血症的 IPF 患者中比 SOT 更能提高运动耐量。这可能是由于通气力学和肌肉氧合的变化所致。需要进一步和更大规模的研究来证实 HFNC 在 IPF 患者中的益处及其在康复计划中的潜在用途。
