Elshof Judith, Oppersma Eline, Wisse Jantine J, Bladder Gerrie, Meijer Petra M, Torres Abel, Wijkstra Peter J, Duiverman Marieke L
Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands.
Respiration. 2024;103(12):723-732. doi: 10.1159/000540780. Epub 2024 Aug 13.
Patients with chronic obstructive pulmonary disease (COPD) commonly experience severe dyspnea after discontinuation of nocturnal noninvasive ventilation (NIV), known as deventilation syndrome (DVS), which negatively affects quality of life. Despite various hypotheses, the precise mechanisms of DVS remain unknown.
An observational pilot study was performed monitoring 16 stable COPD patients before, during, and after an afternoon nap on NIV. Seven patients experienced DVS (Borg Dyspnea Scale ≥5), while nine served as controls (Borg Dyspnea Scale ≤2). Hyperinflation was evaluated through inspiratory capacity (IC) measurements and end-expiratory lung impedance (EELI) via electrical impedance tomography. Respiratory muscle activity was assessed by diaphragmatic surface electromyography (sEMG).
Post-NIV dyspnea scores were significantly higher in the DVS group (5 [3-7] vs. 0 [0-1.5], p < 0.001). IC values were lower in the DVS group compared to controls, both pre-NIV (54 [41-63] vs. 88 [72-94] %pred., p = 0.006) and post-NIV (45 [40-59] vs. 76 [65-82] %pred., p = 0.005), while no intergroup difference was seen in IC changes pre- and post-NIV. EELI values after NIV indicated a tendency towards lower values in controls and higher values in DVS patients. sEMG amplitudes were higher in the DVS group within the first 5-min post-NIV (221 [112-294] vs. 100 [58-177]% of baseline, p = 0.030).
This study suggests that it is unlikely that DVS originates from the inability to create diaphragmatic muscle activity after NIV. Instead, NIV-induced hyperinflation in individuals with static hyperinflation may play a significant role. Addressing hyperinflation holds promise in preventing DVS symptoms in COPD patients.
慢性阻塞性肺疾病（COPD）患者在夜间无创通气（NIV）中断后常出现严重呼吸困难，即脱机综合征（DVS），这对生活质量有负面影响。尽管有各种假说，但DVS的确切机制仍不清楚。
进行了一项观察性试点研究，对16例稳定期COPD患者在午睡期间使用NIV之前、期间和之后进行监测。7例患者出现DVS（Borg呼吸困难量表≥5），9例作为对照（Borg呼吸困难量表≤2）。通过吸气容量（IC）测量和电阻抗断层扫描的呼气末肺阻抗（EELI）评估肺过度充气。通过膈肌表面肌电图（sEMG）评估呼吸肌活动。
DVS组NIV后的呼吸困难评分显著更高（5 [3 - 7] 对比 0 [0 - 1.5]，p < 0.001）。与对照组相比，DVS组的IC值更低，NIV前（54 [41 - 63] 对比 88 [72 - 94] %预计值，p = 0.006）和NIV后（45 [40 - 59] 对比 76 [65 - 82] %预计值，p = 0.005），而NIV前后IC变化的组间差异未见。NIV后的EELI值表明对照组有降低趋势，DVS患者有升高趋势。NIV后前5分钟内，DVS组的sEMG振幅更高（221 [112 - 294] 对比 100 [58 - 177]%基线，p = 0.030）。
本研究表明，DVS不太可能源于NIV后无法产生膈肌肌肉活动。相反，在静态肺过度充气个体中，NIV诱导的肺过度充气可能起重要作用。解决肺过度充气有望预防COPD患者的DVS症状。
