Continuous positive airway pressure increases heart rate variability in congestive heart failure

Butler, G. C.; Naughton, Matthew T.; Rahman, Mohammad A.; Bradley, T. Douglas; Floras, John S.

doi:10.1016/0735-1097(94)00427-r

Cited by 63 publications

(43 citation statements)

References 24 publications

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“…21 Previous electrophysiologic studies have shown that short term application of nasal CPAP increases heart rate variability as well as the time and frequency domain indices of parasympathetic activity without influencing cardiac sympathetic tone. 22 This increase may occur reflexively through stimulation of afferent pulmonary mechanoreceptors.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…The first study to examine the effects In awake patients with HF, CPAP also increases heart rate variability and its vagal modulation. 85 In many respects, these effects of CPAP are analogous to the chronic effects of ␤-blockade in HF, 3 but they are achieved nonpharmacologically by reducing oxygen demand and increasing oxygen supply and by attenuating central sympathetic outflow. Although these short-term results are encouraging, there remains a need for randomized trials to determine whether the specific treatment of OSA in HF will improve long-term morbidity and mortality.…”

Section: Treatment Of Obstructive Sleep Apnea In Heart Failurementioning

confidence: 99%

Sleep Apnea and Heart Failure

2003

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“…Heart rate variability, a marker of prognosis in HF, has been shown to be improved with CPAP. 77 CPAP also causes bronchodilation, 78 which may help overcome the obstruction caused by airway oedema. It also increases end expiratory lung volume in patients with stable HF, 77 an effect that is likely to be duplicated in those with APO.…”

Section: Effect Of Positive Airway Pressure On Lung Function In Acutementioning

confidence: 99%

“…77 CPAP also causes bronchodilation, 78 which may help overcome the obstruction caused by airway oedema. It also increases end expiratory lung volume in patients with stable HF, 77 an effect that is likely to be duplicated in those with APO. Lung compliance improves and lung resistance falls with CPAP reducing the work of breathing (WOB).…”

Section: Effect Of Positive Airway Pressure On Lung Function In Acutementioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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Continuous positive airway pressure increases heart rate variability in congestive heart failure

Cited by 63 publications

References 24 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

Sleep Apnea and Heart Failure

Heart Failure and the Lung

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