The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

NON INVASIVE VENTILATIONALLOWING A FAST PULMONARY REHABILITATION PROGRAM OF A CHRONIC OBSTRUCTIVE PULMONARYDISEASE CASE.

Elizabeth Velloso,MSc.student , Walkyria Sampaio, MSc. Student,Luís Felipe Nogueira, Physician.Faculdade de Saúde e Ecologia Humana, Minas Gerais ? Brazil.

The impaired exercise tolerancein chronic obstructive pulmonary disease (COPD) patients is pivotial to worsenthe pulmonary disease and the persistent state of muscular deconditioning resultingin a extremely sedentary lifestyle. Initially, these patients experience dyspneaon exertion because of defective respiratory mechanics, poor diffusing capacity,compromised gas exchange, and elevated dead space to tidal volume ratio. However,dyspnea becomes the feared result of any attempt to exert. This sets up a mutuallyreinforcing cycle between inactivity and physical deconditioning. The non invasiveventilation (NIV) is a supportive therapeutic method very useful to allow theinclusion and progression of COPD patients in a rehabilitation program despitefew reports in literature using this device during the training. The NIV offersa support to the respiratory muscle weakness, reversing partially the overloadimposed to ventilatory muscles due to the impared lung mechanics. This caseis of a 64-year-old patient, weighting 92 Kg, body mass index (BMI= 33.8 Kg/m2),with a moderate overlap syndrome (PO2=52 mm Hg, PCO2=49 mmHg, SO2=88%, FEV1=1.34L ) and with hypertension andnefropaty as comorbid conditions, oxygen-dependent (using 2L/min). The medicaltreatment involved the prescription of inhaled bronchodilators (b agonists)and anti-hypertensive drugs (diuretic and angiotensin-coverting enzyme inhibitor).The patient in this case had a severe functional limitation to normal dailyactivities with scores based on the Chronic Respiratory Disease Questionnaire(CRDQ ). The NIV was used to start a two-month aerobic training, five timesa week in the treadmill with intensity ranging from 60 to 70% of the maximumheart rate reserve. Dyspnea sensation was also evaluated with the BORG scaleduring the training. As the patient improved his exercise tolerance the supportpressure levels were decreased from 14 to 6 cm H2O until the patient was ableto perform the training without the NIV safely. In addition, it was increasedthe speed (from 2.6 miles to 2.9 miles per hour ) and training time (from 4to 40 minutes). Nowadays, the patient has been performing one hour of aerobictraining per day which also includes the inespecific muscle training (upperand lower-extremity training with a 1.5 Kg load) and the ventilatory muscletraining using the threshold device. The last gasometric results were PO2=68mm Hg , PCO2= 39mm Hg , SO2= 93.4% and his present weightis 80 Kg (BMI= 29,4 Kg/ m2). Overall, the patient has got a greatimprovement on his exercise performance and symptons and therefore, recoveredhis ability to perform the normal daily activities with better quality of life(CRDQ).

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