Thomas M Siler, Shailesh C Patel, Paragkumar Amin, Larry Hamon, George C Dungan II, Ronald J De Bellis, Leonithas I Volakis
Objective: Ambulation and early mobility is used in concert with oxygen therapy, as exercise is linked to improved patient outcomes. Past studies with ambulatory oxygen have evaluated patients with a need for oxygenation and ventilatory support during daily activity. The goal of this study is to establish the feasibility of a low risk model, using High Velocity Nasal Insufflation (HVNI; a form of non-invasive ventilation that augments breathing) providing oxygenation and ventilation support to facilitate ambulation of patients experiencing Dyspnea, and assess the impact of HVNI on outcomes compared to treatment as usual (TAU) in both inpatients and outpatients.
Methods: The study was performed as a prospective, crossover trial of patients across three sites. Patients prescribed ambulation (in the conduct of normal clinical care) were studied on oxygen therapy, and then crossed to HVNI therapy for the subsequent ambulation attempt. Ambulation distance and duration time were primary outcomes, with recovery time, vital signs, patient perception and clinician perception were secondary measurements. Patients with Dyspnea were recruited from both inpatient and outpatient settings.
Results: 32 patients were enrolled, 28 completed both study arms and 25 were analysed after post hoc exclusion. HVNI improved inpatient distance, duration and recovery outcomes: 8.5% increase in walk duration, 12.4% increase in distance walked, 32.5% decrease in recovery time, and the speed was 7.1% faster in HVNI than in TAU. Comparable improvement was not seen among outpatient ambulation.
Conclusion: The study suggests that HVNI during ambulation is feasible and may have more effective improvement in the inpatient acute care population of the study subjects. Enhanced duration and distance whilst reducing recovery time may provide clinical advantage to inpatient ambulation. A larger, randomised controlled study is required to further explore the role of HVNI in rehabilitation and allow for deeper review of outcomes.
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