Enhancement of cardiac performance by bilevel positive airway pressure ventilation in heart failure.

Abstract

BACKGROUND:

Recent studies have reported the clinical usefulness of positive airway pressure ventilation therapy with various kinds of pressure support compared with simple continuous positive airway pressure (CPAP) for heart failure patients. However, the mechanism of the favorable effect of CPAP with pressure support can not be explained simply from the mechanical aspect and remains to be elucidated.

METHODS AND RESULTS:

In 18 stable chronic heart failure patients, we performed stepwise CPAP (4, 8, 12 cm H(2)O) while the cardiac output and intracardiac pressures were continuously monitored, and we compared the effects of 4 cm H(2)O CPAP with those of 4 cm H(2)O CPAP plus 5 cm H(2)O pressure support. Stepwise CPAP decreased cardiac index significantly in patients with pulmonary arterial wedge pressure (PAWP) <12 mm Hg (n = 10), but not in those with PAWP ≥12 mm Hg (n = 8). Ventilation with CPAP plus pressure support increased cardiac index slightly but significantly from 2.2 ± 0.7 to 2.3 ± 0.7 L min(-1) m(-2) (P = .001) compared with CPAP alone, regardless of basal filling condition or cardiac index.

CONCLUSIONS:

Our results suggest that CPAP plus pressure support is more effective than simple CPAP in heart failure patients and that the enhancement might be induced by neural changes and not simply by alteration of the preload level.

• Authors: Masayoshi Yoshida, Toshiaki Kadokami, Hidetoshi Momii, Atsumi Hayashi, Takahisa Urashi, Sumito Narita, Natsumi Kawamura, Shin-ichi Ando
• Journal: Journal of cardiac failure (J Card Fail) Vol. 18 Issue 12 Pg. 912-8 (Dec 2012) ISSN: 1532-8414 [Electronic] United States
• PMID: 23207079 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Oxygen

Topics

• Aged
• Cardiac Output
• Continuous Positive Airway Pressure
• Female
• Heart Failure (therapy)
• Humans
• Intermittent Positive-Pressure Ventilation
• Male
• Middle Aged
• Oxygen (blood)
• Pulmonary Wedge Pressure