Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure

Abstract

SummaryAdaptive servo-ventilation (ASV) has been attracting attention as a novel respiratory support therapy for heart failure (HF). However, the acute hemodynamic effects have not been compared between ASV and continuous positive airway pressure (CPAP) in HF patients.We studied 12 consecutive patients with stable chronic HF. Hemodynamic measurement was performed by right heart catheterization before and after CPAP 5 cmH 2 O, CPAP 10 cmH 2 O, and ASV for 15 minutes each.Heart rate, blood pressure, pulmonary capillary wedge pressure (PCWP), and stroke volume index (SVI) were not changed by any intervention. Right atrial pressure significantly increased after CPAP 10 cmH 2 O (3.6 ± 3.3 to 6.7 ± 1.6 mmHg, P = 0.005) and ASV (4.1 ± 2.6 to 6.8 ± 1.5 mmHg, P = 0.026). Cardiac index was significantly decreased by CPAP 10 cmH 2 O (2.3 ± 0.4 to 1.9 ± 0.3 L/minute/m 2 , P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m 2 , P = 0.299). There was a significant positive correlation between baseline PCWP and % of baseline SVI by CPAP 10 cmH 2 O (r = 0.705, P < 0.001) and ASV (r = 0.750, P < 0.001). ASV and CPAP 10 cmH 2 O had significantly greater slopes of this correlation than CPAP 5 cmH 2 O, suggesting that patients with higher PCWP had a greater increase in SVI by ASV and CPAP 10 cmH 2 O. The relationship between baseline PCWP and % of baseline SVI by ASV was shifted upwards compared to CPAP 10 cmH 2 O. Furthermore, based on the results of a questionnaire, patients accepted CPAP 5 cmH 2 O and ASV more favorably compared to CPAP 10 cmH 2 O.ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients. (Int Heart J 2015; 56: 527-532)

Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

“…Simultaneously, the auto-EPAP modes developed by ASV-manufacturers are available in daily practice, but lack an evidence base for superiority on fixed-EPAP in clinical and bench studies [ 2 , 21 ], and consensual recommendations are clearly absent. The potential for cardiac output worsening due to specific pressure levels is not always counterbalanced by the neurovegetative response [ 19 , 20 , 22 ] and at-risk patients are likely those with a low pulmonary capillary wedge pressure [ 18 ] and a right ventricular dysfunction [ 19 ].…”

Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema

“…ASV therapy is exceedingly effective in a patient with higher PCWP. Asakawa et al demonstrated that ASV has more favorable acute effects on hemodynamics than continuous positive airway pressure (CPAP) in HF patients [21]. Furthermore, there have been several reports showing that ASV has better compliance than CPAP or bi-levelpositive airway pressure (BiPAP) [22].…”

“…PCWP was not mentioned in SERVE-HF but there might be a considerable number of patients with low PCWP. Asakawa et al reported an increase of stroke volume in CPAP 10 cmH 2 O was significantly higher than that in CPAP 5 cmH 2 O [21]. Furthermore, PEEP was also fixed 7.5 cmH 2 O in a randomized study of CPAP for patients with HF [24].…”

“…Furthermore, PEEP was also fixed 7.5 cmH 2 O in a randomized study of CPAP for patients with HF [24]. In a previous ASV study, EEP was fixed 5 cmH 2 O and PS was set from 3 to 10 cmH 2 O [16,19,21]. So, it is sufficient to add EEP 5 cmH 2 O or more for patients with APCE but adding EEP more than 10 cmH 2 O may increase adverse cardiac events.…”

Adaptive Servo-Ventilation Treatment Increases Stroke Volume in Stable Systolic Heart Failure Patients With Low Tricuspid Annular Plane Systolic Excursion

“…10,13) Another group reported that predictors of increased SVI during ASV in HF patients included preserved right ventricular function, normal resting BP, non-ischemic HF etiology, mitral regurgitation, and increased left ventricular filling pressures. 14) Our finding that ASV treatment increased SV in HF patients with low TAPSE appears to contradict their report.…”