Haemodynamic and endocrinological effects of noninvasive mechanical ventilation in respiratory failure

Abstract

The aim of this study was to investigate the haemodynamic and endocrinological effects of noninvasive positive pressure ventilation (NIPPV).Eleven patients with oedema and recent hypercapnic and hypoxaemic worsening of a chronic respiratory insufficiency were included. Echocardiography, cardiac radionuclide assessment, blood catecholamines, salt and water handling hormones were measured at admission and discharge (long study (LS)). To discriminate between the action of NIPPV and other treatments, measurements were performed on the fourth day, for 4 h without NIPPV and 4 h with NIPPV (short study (SS)).NIPPV entailed a correction of Pa,CO 2 and an increase of Pa,O 2 in LS and SS. Oedema disappeared. Body weight decreased (from 85±42 to 81±40 kg) during LS. Systolic and mean pulmonary arterial pressure decreased in LS and SS. Right ventricular ejection fraction increased in LS. Left ventricular ejection fraction did not change. Cardiac index was normal on admission and then decreased. Natriuretic peptides and catecholamines were increased on admission, whereas plasma renin activity, aldosterone and vasopressin were normal.We suggest that in these patients, oedema can occur independently of reninangiotensin-aldosterone-vasopressin and with a normal cardiac output. Noninvasive positive pressure ventilation allowed a correction of blood gases, associated with the resolution of oedema, a decrease in pulmonary arterial pressures and an increase in right ventricular ejection fraction. Eur Respir J 1997; 10: 2553-2559 Severe chronic respiratory insufficiency often leads to pulmonary arterial hypertension and cor pulmonale, which are associated with increased mortality [1]. Peripheral oedema is often witnessed in these patients, and the traditional view has been to assume that this results from right ventricular failure and/or the increased secretion of salt and water-handling hormone [2,3]. Longterm noninvasive positive pressure ventilation (NIPPV) is effective in improving blood gases and thereby decreasing pulmonary hypertension, clearing oedema, and reducing morbidity and mortality associated with this condition [4]. Its beneficial effects on oedema could result from improved right ventricular function and cardiac output as well as a lowering of salt and water-handling hormone levels, as demonstrated during invasive mechanical ventilation [5]. However, there is a scarcity of published data on the consequences of NIPPV on pulmonary haemodynamics, ventricular function and hormonal patterns in oedematous patients with chronic respiratory insufficiency in which long-term ventilatory support is initiated.The aims of this study were, therefore: 1) to measure the haemodynamic effects of NIPPV, which would be expected to reduce pulmonary arterial pressure and improve right ventricular ejection fraction because of the correction of Pa,CO 2 and Pa,O 2 ; 2) to explore the haemodynamic and endocrine profiles of patients during a recent worsening of chronic hypercapnic respiratory insufficiency, in particular the major h...

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

“…2 This is true even though oxygen therapy exacerbates hypercapnia, whereas NIV has been demonstrated to improve the prognosis for kyphoscoliosis patients 21,22 and others with respiratory muscle dysfunction by comparison with oxygen therapy. 2,23,24 Indeed, NIV alone has been shown to be effective in normalizing CO 2 and PaO 2 levels as well as pulmonary artery pressures, without concomitant oxygen therapy for kyphoscolisois patents.…”

Lung Disease and Hypertension

“…They may nonselectively dilate the vessels in hypoventilated areas of the lung and worsen hypoxemia [26]. As mentioned above, biphasic positive airway pressure can improve the right ventricular function [55]. …”

“…Biphasic positive airway pressure can improve the right ventricular function and decrease plasma levels of natriuretic peptides [55]. Combined approaches are needed to manage these comorbidities of COPD such as heart failure.…”

New Aspects in Mechanical Ventilation

“…Therefore, such patients have a small tidal volume, which is inadequately compensated for by an increase in respiratory rate. Their rapid shallow breathing with a limited carbon dioxide removal may be improved by NIV and it can reverse clinical abnormalities related to hypoxemia, hypercapnia, and acidosis [90,91] resulting in avoidance of endotracheal intubation and reduction of complications, length of stay, and finally improving survival in patients with COPD [92][93][94]. Furthermore, NIV can be considered in patients with a do-notintubate order, especially in those with a diagnosis of congestive heart failure or chronic obstructive pulmonary disease, who have strong coughing, or who are not sedated due to a better prognosis [95].…”