THE EFFECT OF NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE ON PLASMA ENDOTHELIN-1 CONCENTRATIONS IN PATIENTS WITH SEVERE CARDIOGENIC PULMONARY-EDEMA

We investigated the effects of nasal continuous positive airway pressu re (CPAP) on plasma endothelin-l (ET-1) concentrations in patients wit h cardiogenic pulmonary edema. Thirty patients were randomly assigned to two groups: 15 patients who received oxygen plus nasal CPAP (CPAP g roup), and 15 patients who received only oxygen by face mask (oxygen g roup). The heart rate and the mean pulmonary artery pressure decreased significantly in the CPAP group. The PaO2/fraction of inspired oxygen (Fro,) ratio increased in the CPAP group (163 +/- 70 to 332 +/- 104, P < 0.01) after 6 h and was significantly higher than that in the oxyg en group. Arterial plasma ET-1 concentrations decreased from 6.2 +/- 2 .0 pg/mL to 4.8 +/- 1.7 pg/mL (P < 0.05) after 6 h and to 3.3 +/- 0.7 pg/mL (P < 0.01) after 24 h in the CPAP group. Arterial plasma ET-I co ncentrations in the CPAP group compared with the oxygen group were sig nificantly lower at 24 h. There was a correlation between the arterial plasma ET-1 concentrations and mean pulmonary artery pressure (r = 0. 62, P < 0.001), and PaO2/FIO2 (r = -0.46, P < 0.01). Nasal CPAP led to an early decrease in plasma ET-1 concentrations, and improvement in o xygenation and hemodynamics.