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

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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