Effect of Continuous Positive Airway Pressure on Intrathoracic and Left Ventricular Transmural Pressures in Patients With Congestive Heart Failure

Naughton, Matthew T.; Rahman, Mohammad A.; Hara, Kazuhiro; Floras, John S.; Bradley, T. Douglas

doi:10.1161/01.cir.91.6.1725

Cited by 404 publications

(260 citation statements)

References 42 publications

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“…The fact that ventilatory parameters during sleep were improved in all patients with the same settings suggests that the beneficial effects of positive intrathoracic pressure upon the failing heart are the predominant mechanism of benefit. In various studies, BRADLEY and co-workers [11,26] demonstrated that CPAP is effective not only in improving respiratory events but also in reducing cardiac pre and after load, transmural pressure of intrathoracic blood vessels [32] and cardiac dimensions [33]. The current finding of a reduction in circulation time is also consistent with improved cardiac performance.…”

Section: Discussionsupporting

confidence: 57%

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Köhnlein¹,

Welte²,

Tan³

et al. 2002

European Respiratory Journal

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Patients with chronic congestive cardiac failure (CCF) frequently suffer from central sleep apnoea syndrome (CSAS). Continuous positive airway pressure (CPAP) has been suggested as a treatment. The authors hypothesised that bilevel ventilation might be easier to initiate and superior to CPAP at correcting the sleeprelated abnormality of breathing in patients with CCF.After excluding those with a history suggestive of obstructive sleep apnoea, 35 patients with CCF (left ventricular ejection fraction v35%) were screened with overnight oximetry and the diagnosis of CSAS was established with polysomnography in 18. Two 14-day cycles of CPAP (0.85 kPa (8.5 mbar)) or bilevel ventilation (0.85/0.3 kPa (8.5/3 mbar)) in random order, were compared in a crossover study.Sixteen patients (13 males), mean age 62.0 ¡ 7.4 yrs completed the study. The pretreatment apnoea/hypopnoea index of 26.7¡10.7 was significantly reduced by CPAP and bilevel ventilation to 7.7¡5.6 and 6.5¡6.6, respectively. The arousal index fell from 31.1¡10.0 per hour of sleep to 15.7¡5.4 and 16.4¡6.9, respectively. Significant and equal improvements with CPAP and bilevel ventilation were found for sleep quality, daytime fatigue, circulation time and New York Heart Association class.The authors conclude that continuous positive airway pressure and bilevel ventilation equally and effectively improve Cheyne-Stokes respiration in patients with congestive cardiac failure. Eur Respir J 2002; 20: 934-941.

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Section: Discussionsupporting

confidence: 57%

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Köhnlein¹,

Welte²,

Tan³

et al. 2002

European Respiratory Journal

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“…79 There is also a reduction in the intrathoracic pressure swings and respiratory rate, representing a fall in respiratory muscle effort and leading to reduced left ventricular transmural pressure. 80 It has been previously demonstrated that as WOB increases, there is significant increase in blood flow to the respiratory muscles and an attendant increase in oxygen consumption. 81 CPAP's role in reducing this WOB explains why overall oxygen consumption falls in HF patients on CPAP.…”

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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“…For this reason, there is a significant reduction in respiratory muscle overload and inhibition of the sympathetic response to these muscles. 14,18,22,23 Moreover, CHF patients have to deal with increased respiratory rates due to stimulation of the atrial chamber, as well as an increase of the afferent impulse of the receptors in pulmonary vessels and stimulation of the J mechanoreceptors, which result in rapid and shallow breathing. For this reason, the sympathetic nervous system is activated leading to an increase in HR in order to maintain an adequate CO. 13,22,24 The application of noninvasive mechanical ventilation with positive pressure in patients with cardiac abnormalities increases pleural pressure, thus increasing intrathoracic pressure, and resulting in inhibition of the autonomous sympathetic nervous system.…”

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 Continuous Positive Airway Pressure on Intrathoracic and Left Ventricular Transmural Pressures in Patients With Congestive Heart Failure

Cited by 404 publications

References 42 publications

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Heart Failure and the Lung

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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