Impact of high-intensity non-invasive ventilation on cardiac function in stable hypercapnic COPD: A randomised cross-over trial

Rationale Although high-intensity non-invasive ventilation (HI-NIV) has been shown to improve outcomes in stable hypercapnic COPD, it may adversely affect cardiac output (CO). Aims: To compare cardiac and pulmonary effects of 6 weeks low-intensity NIV (LI-NIV) and 6 weeks HI-NIV in stable COPD. Design of the study In a randomised crossover study, change in echocardiographically measured CO after 6 weeks of each NIV mode compared to baseline was assessed in 14 stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and quality of life were investigated. Results 3 patients dropped out (2 deteriorated on LI-NIV, 1 patient presented with decompensated heart failure based on a coronary artery stenosis; NIV did not affect her CO (baseline 4.3 l/min, under HI-NIV 4.5 l/min)). 11 patients were included for analysis. CO and NTproBNP did not change (change CO: LI-NIV 4% (95% CI -17 to 12) vs. HI-NIV; -3% (-15 to 22); treatment effect HI vs LI: -9% (-27 to 10)). Both modes improved FEV 1 and the Severe Respiratory Insufficiency Summary Score (SRI-SS). HI-NIV tended to improve hypercapnia more. However, changes were not different between HI- and LI-NIV . Conclusion Longer-term NIV does not affect CO, even not with HI-NIV.