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Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure
Philip-Joet FF, Paganelli FFF, Dutau HL
Respiration 1999 Mar-Apr;66(2):136-143
clinical trial
3/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIMS: Benefits of nasal continuous positive airway pressure (CPAP) in patients presenting with chronic heart failure (CHF) are controversial. The purpose of this study was to compare the hemodynamic effects of CPAP and bilevel positive airway pressure (BiPAP) in patients with or without CHF. METHODS AND RESULTS: Twenty patients with CHF and 7 with normal left ventricular function underwent cardiac catheterization. Measurements were made before and after three 20-min periods of BiPAP: expiratory positive airway pressure (EPAP) = 8 cmH2O and inspiratory positive airway pressure (IPAP) = 12 cmH2O, EPAP = 10 cmH2O and IPAP = 15 cmH2O, and CPAP = EPAP = IPAP = 10 cmH2O administered in random order. Positive pressure ventilation decreased cardiac output (CO) and stroke volume. No change was observed in either pulmonary or systemic arterial pressure. There was no difference in the hemodynamic effects of the three ventilation settings. Only mean pulmonary wedge pressure (MPWP) and heart rate were lower with CPAP than with BiPAP. CO decreased only in patients with low MPWP (<= 12 mmHg). BiPAP ventilation increased PaO2 and decreased PaCO2 more than CPAP. CONCLUSIONS: In patients with cardiac failure, a decrease in CO occurs both during CPAP and BiPAP, when pulmonary wedge pressure is low (<= 12 mmHg).

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