Full-Face versus nasal mask for high intensity noninvasive ventilation in COPD patients with chronic hypercapnic respiratory insufficiency– a randomized crossover trial –

Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.

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A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes

Diabetes Care ◽

10.2337/dc21-1593 ◽

2021 ◽

pp. dc211593

Author(s):

Barbora Paldus ◽

Dale Morrison ◽

Dessi P. Zaharieva ◽

Melissa H. Lee ◽

Hannah Jones ◽

...

Keyword(s):

Type 1 Diabetes ◽

Resistance Exercise ◽

Glucose Control ◽

High Intensity ◽

Closed Loop ◽

Crossover Trial ◽

Insulin Delivery ◽

Moderate Intensity ◽

Randomized Crossover Trial

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A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes

10.2337/figshare.16892092.v2 ◽

2021 ◽

Author(s):

Barbora Paldus ◽

Dale Morrison ◽

Dessi P. Zaharieva ◽

Melissa H. Lee ◽

Hannah Jones ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Control ◽

High Intensity ◽

Kinetic Data ◽

Closed Loop ◽

Crossover Trial ◽

Moderate Intensity ◽

Post Exercise ◽

Randomized Crossover Trial

Objective: To compare glucose control with hybrid closed loop (HCL) when challenged by moderate-intensity exercise (MIE), high-intensity intermittent exercise (HIE) and resistance exercise (RE) while profiling counter-regulatory hormones, lactate, ketones, and kinetic data in adults with type 1 diabetes. Methods: <a>Open-label multisite randomized crossover trial. </a><a>Adults with type 1 diabetes undertook 40 min of HIE, MIE, and RE in random order while using HCL (Medtronic 670G) with a temporary target set 2 hours prior to and during exercise and 15g carbohydrates if pre-exercise glucose was <126mg/dL, to prevent hypoglycemia.</a> Primary outcome was median (IQR) continuous glucose monitoring (CGM) time-in-range (TIR, 70-180 mg/dL) for 14 hours post-exercise commencement. Accelerometer data and venous glucose, ketones, lactate, and counter-regulatory hormones were measured for 280 min post-exercise commencement. Results: Median TIR was 81% [67, 93]%, 91% [80, 94]%, and 80% [73, 89]% for 0-14 hours post-exercise commencement for HIE, MIE and RE, respectively (n=30), with no difference between exercise types (MIE v HIE; p=0.11, MIE v RE p=0.11, HIE v RE p=0.90). Time-below-range was 0% for all exercise bouts. For HIE and RE compared with MIE, there were greater increases respectively in noradrenaline (p=0.01, p=0.004), cortisol (p<0.001, p=0.001), lactate (p£0.001, p£0.001) and heart rate (p=0.007, p=0.015). During HIE compared with MIE, there were greater increases in growth hormone (p=0.024). Conclusions: Under controlled conditions, HCL provided satisfactory glucose control with no difference between exercise type. Lactate, counter-regulatory hormones, and kinetic data differentiate type and intensity of exercise, and their measurement may help inform insulin needs during exercise. However, their potential utility as modulators of insulin dosing will be limited by the pharmacokinetics of subcutaneous insulin delivery.

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Effect of a conical PEP-mask on dyspnea and exercise endurance in COPD patients: a randomized crossover trial

10.1183/13993003.congress-2018.pa3636 ◽

2018 ◽

Author(s):

Chatchai Phimphasak ◽

Malipron Pukdeechat ◽

David Jones ◽

Chulee Ubolsakka-Jones

Keyword(s):

Crossover Trial ◽

Randomized Crossover Trial ◽

Copd Patients ◽

Exercise Endurance

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A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes

10.2337/figshare.16892092 ◽

2021 ◽

Author(s):

Barbora Paldus ◽

Dale Morrison ◽

Dessi P. Zaharieva ◽

Melissa H. Lee ◽

Hannah Jones ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Control ◽

High Intensity ◽

Kinetic Data ◽

Closed Loop ◽

Crossover Trial ◽

Moderate Intensity ◽

Post Exercise ◽

Randomized Crossover Trial

Objective: To compare glucose control with hybrid closed loop (HCL) when challenged by moderate-intensity exercise (MIE), high-intensity intermittent exercise (HIE) and resistance exercise (RE) while profiling counter-regulatory hormones, lactate, ketones, and kinetic data in adults with type 1 diabetes. Methods: <a>Open-label multisite randomized crossover trial. </a><a>Adults with type 1 diabetes undertook 40 min of HIE, MIE, and RE in random order while using HCL (Medtronic 670G) with a temporary target set 2 hours prior to and during exercise and 15g carbohydrates if pre-exercise glucose was <126mg/dL, to prevent hypoglycemia.</a> Primary outcome was median (IQR) continuous glucose monitoring (CGM) time-in-range (TIR, 70-180 mg/dL) for 14 hours post-exercise commencement. Accelerometer data and venous glucose, ketones, lactate, and counter-regulatory hormones were measured for 280 min post-exercise commencement. Results: Median TIR was 81% [67, 93]%, 91% [80, 94]%, and 80% [73, 89]% for 0-14 hours post-exercise commencement for HIE, MIE and RE, respectively (n=30), with no difference between exercise types (MIE v HIE; p=0.11, MIE v RE p=0.11, HIE v RE p=0.90). Time-below-range was 0% for all exercise bouts. For HIE and RE compared with MIE, there were greater increases respectively in noradrenaline (p=0.01, p=0.004), cortisol (p<0.001, p=0.001), lactate (p£0.001, p£0.001) and heart rate (p=0.007, p=0.015). During HIE compared with MIE, there were greater increases in growth hormone (p=0.024). Conclusions: Under controlled conditions, HCL provided satisfactory glucose control with no difference between exercise type. Lactate, counter-regulatory hormones, and kinetic data differentiate type and intensity of exercise, and their measurement may help inform insulin needs during exercise. However, their potential utility as modulators of insulin dosing will be limited by the pharmacokinetics of subcutaneous insulin delivery.

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Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial

Sleep And Breathing ◽

10.1007/s11325-018-01772-5 ◽

2019 ◽

Vol 23 (3) ◽

pp. 885-888

Author(s):

Antoine Léotard ◽

Matthieu Lesgoirres ◽

Najeh Daabek ◽

Marius Lebret ◽

Sebastien Bailly ◽

...

Keyword(s):

Crossover Trial ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Nasal Mask ◽

Randomized Crossover Trial ◽

Oronasal Mask

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Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132009000200010 ◽

2009 ◽

Vol 35 (2) ◽

pp. 164-173 ◽

Cited By ~ 29

Author(s):

Marcelo Alcantara Holanda ◽

Ricardo Coelho Reis ◽

Georgia Freire Paiva Winkeler ◽

Simone Castelo Branco Fortaleza ◽

José Wellington de Oliveira Lima ◽

...

Keyword(s):

Adverse Effects ◽

Noninvasive Ventilation ◽

Crossover Trial ◽

Positive Airway Pressure ◽

Ventilator Circuit ◽

Short Term ◽

Air Leaks ◽

Randomized Crossover Trial ◽

Bilevel Positive Airway Pressure ◽

Mask Type

OBJECTIVE: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. METHODS: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. RESULTS: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO2 entering the ventilator circuit was zero for the TFM. CONCLUSIONS: The short-term adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO2 from the circuit is less likely to occur when a TFM is used.

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