Effect of Nasal Continuous Positive Airway Pressure on Cardiac Output and Oxygen Delivery in Patients with Congestive Heart Failure

Baratz, David; Westbrook, Philip R.; Shah, Prediman K.; Mohsenifar, Zab

doi:10.1378/chest.102.5.1397

Cited by 142 publications

(64 citation statements)

References 16 publications

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“…The potential benefits of continuous positive airway pressure (CPAP) ventilation include an improvement in oxygenation, a decrease in respiratory work, and a decrease in left ventricular afterload. [2][3][4][5] If CPAP using a mask is utilized in patients with cardiogenic pulmonary edema, the number of patients that later require mechanical ventilation by means of endotracheal intubation can be reduced, while oxygenation and respiratory rate are improved. 6 Further, we have reported that nasal CPAP led to an early decrease in plasma endothelin-1 (ET-1) concentrations in patients with severe cardiogenic pulmonary edema.…”

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confidence: 99%

Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial Infarction

Takeda¹,

Nejima²,

Takano³

et al. 1998

Jpn Circ J

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ardiogenic pulmonary edema, which is a common complication of acute myocardial infarction, remains a serious clinical problem. 1 If pulmonary edema results in hypoxemia, mechanical ventilation with positive end-expiratory pressure (PEEP) is required. Mechanical ventilation, however, has associated morbidity. The potential benefits of continuous positive airway pressure (CPAP) ventilation include an improvement in oxygenation, a decrease in respiratory work, and a decrease in left ventricular afterload. [2][3][4][5] If CPAP using a mask is utilized in patients with cardiogenic pulmonary edema, the number of patients that later require mechanical ventilation by means of endotracheal intubation can be reduced, while oxygenation and respiratory rate are improved. 6 Further, we have reported that nasal CPAP led to an early decrease in plasma endothelin-1 (ET-1) concentrations in patients with severe cardiogenic pulmonary edema. 7 In practice, however, there are no generally accepted criteria for the initiation of mechanical ventilation in patients with pulmonary edema in the setting of acute myocardial infarction. Accordingly, the primary goal of the present study was to determine the effects of different methods of respiratory management on the hemodynamics, oxygenation, and outcome in patients who developed respiratory failure due to severe cardiogenic pulmonary edema after acute myocardial infarction. Patients and MethodsThis study was approved by the Committee on Human Patients. Because of the severity of cardiogenic pulmonary edema, no patient was able to give valid informed consent at entry into the study. Therefore, information was provided to the patient's next of kin and their consent was obtained prior to study entry. During the 1-year study period, we prospectively studied 31 of 147 patients with acute myocardial infarction admitted to the coronary care unit (CCU) of our hospital. Of these, one patient with left ventricular free wall rupture and another with ventricular septal perforation were excluded. The remaining patients consisted of 29 adults with respiratory failure due to severe cardiogenic pulmonary edema. All patients with cardiogenic pulmonary edema who had clinical evidence of respiratory distress and a PaO2 below 80 mmHg while receiving 50% oxygen by tight-fitting mask were enrolled.Cardiogenic pulmonary edema was diagnosed if a patient had dyspnea of sudden onset, typical findings on Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial InfarctionJpn Circ J 1998; 62: 553 -558 Shinhiro Takeda, MD; Jun Nejima, MD; Teruo Takano, MD; Kazuhiro Nakanishi, MD; Morimasa Takayama, MD; Atsuhiro Sakamoto, MD*; Ryo Ogawa, MD* Cardiogenic pulmonary edema is a frequent cause of reparatory failure. We investigated the effects of nasal continuous positive airway pressure (CPAP) in patients with severe pulmonary edema associated with acute myocardial infarction. Twenty-nine consecutive patients were divided into 3 groups: firstly, 7 intubated patients who rece...

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confidence: 99%

Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial Infarction

Takeda¹,

Nejima²,

Takano³

et al. 1998

Jpn Circ J

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“…PAP is also suggested to reduce afterload by increasing the intrathoracic pressure and to improve the myocardiac energy requirement. 32,33 Left ventricular wall stress is mainly determined by the systolic BP and LVESV.…”

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confidence: 99%

In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure

Khayat

Abraham

Patt

et al. 2009

Chest

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“…Moreover, ventricular diastolic filling in patients with sinus rhythm is significantly increased by atrial contraction. However, patients with atrial fibrillation do not show the same response since CPAP had a deleterious effect on ventricular preload 40 .…”

Section: Barros Et Al Analysis Of Ventilation and Hemodynamic Changesmentioning

confidence: 99%

Análise das alterações ventilatórias e hemodinâmicas com utilização de ventilação mecânica não-invasiva com binível pressórico em pacientes com insuficiência cardíaca congestiva

Barros¹,

Barros²,

Sangean³

et al. 2007

Arq. Bras. Cardiol.

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Objective: To observe in practice how noninvasive bilevel positive pressure, applied at different levels, may interfere with systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), in patients with congestive heart failure (CHF).Methods: Fourteen CHF patients (mean age 62.85 years) were treated with noninvasive bilevel mechanical ventilation. Patients were consecutively treated with an expiratory positive airway pressure (EPAP) of 5 cmH2O, 10 cmH2O, 15 cmH2O, the expiratory pressure (EPAP). Ventilation and hemodynamic data were collected at these time points, as well as 5 minutes before the beginning of the protocol and 5 minutes after its completion.Results: A statistically significant difference was observed in the respiratory rate between the moment just before the beginning of the protocol and 5 minutes after positive pressure mask placement (p=0.022), and in oxygen saturation, between the final minute of EPAP at 5 cmH2O and after the removal of the mask (p=0.05). Conclusion:Noninvasive bilevel mechanical ventilation improves oxygenation and reduces respiratory work, thus being beneficial for patients with congestive heart failure. It was not possible to observe statistically significant changes in the hemodynamic data due to the small number of patients and to other associated heart diseases.

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Effect of Nasal Continuous Positive Airway Pressure on Cardiac Output and Oxygen Delivery in Patients with Congestive Heart Failure

Cited by 142 publications

References 16 publications

Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial Infarction

Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial Infarction

In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure

Análise das alterações ventilatórias e hemodinâmicas com utilização de ventilação mecânica não-invasiva com binível pressórico em pacientes com insuficiência cardíaca congestiva

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