continuous positive airway pressure

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Letter to the Editor

Acute Effects of Continuous Positive Airway Pressure on Pulse Pressure in CHF

Jacobo Bacariza Blanco et al. Antonio M. Esquinas

Today’s reality on non-invasive ventilation (NIV) use has nothing but four key A level indications supported by evidence-based medicine. These, which would be chronic obstructive pulmonary disease (COPD) exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and the weaning of already extubated COPD patients, are the so called “the fabulous four”. But is this the maximum therapeutic potential of NIV? Probably not. If so, which would be the next one on this selected “fabulous four” group? Maybe it is stable chronic heart failure (CHF). If so, we would be facing a new frontier, yet unexplored, of those chronically stable not respiratory but cardiac patients, opening new applications, none existent up to today.

Quintão et al. move on into the next step to conquer this new frontier, the NIV application on stable CHF. They do so, analyzing the NIV (Continuous Positive Airway Pressure – CPAP) effects on pulse pressure (PP), as a risk factor with independent negative predictive value for adverse cardiovascular events, followed by left ventricular dysfunction, especially type II, caused by acute myocardial ischemia. They prove not only to affect PP reduction, but also heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP) and respiratory rate (RR).

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Artigo Original

Effects of the continuous positive airway pressure on the airways of patients with chronic heart failure

João Carlos Moreno de Azevedo et al. Edison Ramos Migowisk de Carvalho Luis Augusto Feijó Fátima Palha de Oliveira … Sara Lúcia Silveira de Menezes Henrique Murad

BACKGROUND: Heart failure can present with asymptomatic dysfunction at decompensation, with limitations and decrease in the productive capacity. The Continuous Positive Airway Pressure (CPAP) is a non-pharmacological means to decrease afterload. OBJECTIVE: To analyze the effects of CPAP (10 cmH2O), for 30 days in patients with chronic heart failure. METHODS: We assessed 10 patients with heart failure (6 males, 4 females) of several etiologies, with a mean age of 54 ± 14 years, with a BMI of 21 ± 0.04 kg/m². The therapy was applied for 60 min., 5 times a week for 30 days, during the daytime. The echocardiogram and the ergospirometry were analyzed, before and 30 days after the therapy. RESULTS: There was a 19.59% increase in the left ventricular ejection fraction (LVEF): 23.9 ± 8.91 vs 27.65 ± 9.56%; p = 0.045. At the ergospirometry, the exercise time (ET) showed a significant increase from 547 ± 151.319 vs 700 ± 293.990 sec., p = 0.02; oxygen consumption (VO2) was 9.59 ± 6.1 vs 4.51 ± 2.67 ml.kg-1.min.-1, p = 0.01, whereas the carbon dioxide production (VCO2) at rest (9.85 ± 4.38 vs 6.44 ± 2.88 ml.kg-1.min.-1, p = 0.03) decreased. CONCLUSION: The CPAP resulted in an increase in the LVEF and ET, decreased the oxygen consumption and the carbon dioxide production at rest.

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Comparative study between intermittent (Müller Reanimator) and continuous positive airway pressure in the postoperative period of coronary artery bypass grafting

Andréa Pires Müller et al. Márcia Olandoski Rafael Macedo Constantino Costantini Luiz César Guarita-Souza

OBJECTIVE: To compare the effect of the use of intermittent and continuous positive airway pressure in postoperative patients undergoing coronary artery bypass grafting. METHODS: This study included forty patients divided into two groups: one undergoing continuous positive airway pressure (CPAP Group), and the other undergoing intermittent pressure (Müller Resuscitator Group). The patients were evaluated in relation to the several study variables at the following time points: preoperative, 3rd, 24th, and 48th hours. RESULTS: The patient groups were homogeneous in relation to the several demographic and clinical variables. The values of pO2, pCO2 and sO2 were within normal limits and no significant differences were found between the groups. Regarding respirometry, the groups showed significant differences in the tidal volume and respiratory rate at the 48th postoperative hour. Dyspnea and use of accessory muscle in postoperative assessments were found with a significantly higher frequency in patients undergoing CPAP. Patients undergoing Müller Resuscitator had a normal chest radiograph more frequently than did patients undergoing CPAP. CONCLUSION: Both devices were shown to be able to keep pO2, pCO2, and sO2 values within normal limits. However, when the objective was pulmonary reexpansion with less imposed workload, the Müller Resuscitator was more effective because of its prompter action and consequently lower levels of dyspnea, respiratory rate (RR) and use of accessory muscle were observed.

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Acute Effects of Continuous Positive Airway Pressure on Pulse Pressure in CHF

Effects of the continuous positive airway pressure on the airways of patients with chronic heart failure

Comparative study between intermittent (Müller Reanimator) and continuous positive airway pressure in the postoperative period of coronary artery bypass grafting

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