Acute Antiarrhythmic Effects of Bi-Level Positive Airway Pressure Ventilation in Patients with Acute Respiratory Failure Caused by Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

Abstract

Background: Cardiac arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) and may be life threatening. Recently, non-invasive positive pressure ventilation has been advanced as a useful tool in COPD patients with ARF. This method can affect global cardiac performance through its effects on many determinants of cardiac function and may be helpful in reducing arrhythmias. Objective: To assess the role of bi-level positive pressure ventilation (BiPAP) in the management of cardiac arrhythmias in patients with ARF caused by COPD. Methods: We studied 30 consecutive patients with ARF related to COPD diagnosed according to American Thoracic Society criteria. All subjects were smokers; the mean age was 68 ± 7 years. They were randomly assigned to receive BiPAP plus standard therapy (group 1) or standard therapy alone (group 2). Patients randomized to receive BiPAP were first fitted with a nasal mask, and BiPAP was administered after 12 h of standard therapy. All subjects were studied using a computerized 24-hour Holter ECG. Blood gases, plasma electrolytes, respiratory rate and blood pressure were measured at study entry, at 30, 60 and 120 min and then every 3 h. Results: Heart rate decreased from 86.08 ± 7.86 to 74.92 ± 5.39 in group 1 (p < 0.001) versus 82.77 ± 8.78 to 75.82 ± 6.76 in group 2 (p = 0.033). Ventricular premature complexes decreased from 564.38 ± 737.36 to 166.15 ± 266.26 in group 1 (p < 0.001) versus 523.38 ± 685.75 to 353.54 ± 469.93 in group 2 (p = 0.021). Atrial premature complexes decreased from 570.00 ± 630.36 to 152.31 ± 168.88 in group 1 (p < 0.001) versus 513.77 ± 553.81 to 328.62 ± 400.81 in group 2 (p = 0.021). Conclusions: Cardiac arrhythmias decreased significantly in both groups after the start of both treatments, although data obtained from group 1 revealed a more important statistical significance. Our data seem to support the hypothesis that BiPAP may be a useful tool in managing COPD patients with ARF and mild arrhythmias.

Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

“…NPPV has emerged as a significant advance in the management of respiratory failure [9,10,11], especially in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) [12] and cardiogenic pulmonary edema [6, 13]. Following the good results obtained in these patients, NPPV is now currently under clinical evaluation as a possible alternative to conventional ventilation with endotracheal intubation and as a mean to reduce the need for intubation during ARF that is not related to COPD [10, 11, 14, 15].…”

Noninvasive Assisted Pressure-Controlled Ventilation: As Effective as Pressure Support Ventilation in Chronic Obstructive Pulmonary Disease?

“…Nevertheless, NIV is generally tolerated much better than IMV, owing to lower inflation pressures. There are also some data supporting the beneficial effects of NIV in COPD patients with mild arrhythmias [22]. All in all, every mechanical ventilation procedure must be performed very carefully, especially in patients with hemodynamic instability or accompanying cardiac disease.…”

Treatment-Related Risk Factors for Development of Skin Breakdown in Subjects With Acute Respiratory Failure Undergoing Noninvasive Ventilation or CPAP

“…4,5 The main clinical indications for the use of NIV are directed to the treatment of COPD exacerbation, acute pulmonary edema, pulmonary infection in immunosuppressed subjects, and, in some specific cases, acute pancreatitis. [6][7][8][9][10][11][12] NIV has also been employed to prevent re-intubation in subjects who developed postextubation respiratory failure and to shorten the duration of invasive mechanical ventilation by facilitating weaning (earlier extubation). 13,14 Although the use of NIV improves clinical outcomes, some complications and deleterious effects have also been recognized in clinical practice, such as aspiration, hemodynamic instability, dryness of secretions, and patientventilator asynchrony.…”