Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction

Background and study objectives: Noninvasive positive airway pressure may p lay a significant role in treating patients with congestive heart failure ( CHF). We tested our hypothesis that noninvasive bilevel positive airway pre ssure improves left ventricular performance in patients with chronic CHF se condary to severe systolic dysfunction. Objectives: To determine the cardiac performance of patients using bilevel positive airway pressure, and to describe the hemodynamic effects of bileve l positive airway pressure and its use as a therapeutic adjunct in these pa tients. Design: Prospective, cohort, nonrandomized study. Setting: Outpatient medicine clinic. Patients: Fourteen patients (9 men and 5 women) with stable chronic CHF wit h left ventricular ejection fraction less than or equal to 35%; mean age wa s 60.6 years (range, 43 to 87 years). Interventions: Bilevel positive airway pressure via nasal mask at an inspir atory pressure of 5 cm H2O and an expiratory pressure of 3 cm H2O on sponta neous mode at room air for 1 h. Measurements and results: Myocardial performance and changes were measured using clinical and echocardiographic parameters. Baseline clinical and echo cardiographic parameters were compared with the same parameters after 1 h o f bilevel positive airway pressure. Statistically significant (p < 0.05. Wi lcoxon matched pair signed-rank test) decreases were noted in these mean va lues: systolic BP from 136.21 to 124.14 mm Hg (p = 0.008), heart rate from 85.07 to 74.71 beats/min (p = 0.002), respiratory rate from 23.07 to 15.43 breaths/min (p = 0.001), and systemic vascular resistance from 1671.46 to 1 236.27 dyne . s . cm(3) (p = 0.001). Statistically significant increases we re noted in these mean values: cardiac output from 5.09 to 6.37 L/min (p = 0.004), ejection fraction from 28.71% to 34.36% (p = 0.001), and end-diasto lic volume from 224.36 to 246.21 mL (p = 0.045). Conclusion: Bilevel positive airway pressure has excellent potential for im proving left ventricular performance of patients with chronic CHF secondary to severe systolic dysfunction.