Analysis of ventilation and hemodynamic changes resulting from noninvasive bilevel pressure mechanical ventilation applied to patients with congestive heart failure.
OBJECTIVE
To observe in practice how noninvasive bilevel positive pressure, applied at different levels, may interfere with systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), in patients with congestive heart failure (CHF).


METHODS
Fourteen CHF patients (mean age 62.85 years) were treated with noninvasive bilevel mechanical ventilation. Patients were consecutively treated with an expiratory positive airway pressure (EPAP) of 5 cmH2O, 10 cmH2O, 15 cmH2O, 10 cmH2O, and 5 cmH2O, maintaining a variation in pressure (deltaP) of 5 cmH2O between the inspiratory pressure (IPAP) and the expiratory pressure (EPAP). Ventilation and hemodynamic data were collected at these time points, as well as 5 minutes before the beginning of the protocol and 5 minutes after its completion.


RESULTS
A statistically significant difference was observed in the respiratory rate between the moment just before the beginning of the protocol and 5 minutes after positive pressure mask placement (p=0.022), and in oxygen saturation, between the final minute of EPAP at 5 cmH2O and after the removal of the mask (p=0.05).


CONCLUSIONS
Noninvasive bilevel mechanical ventilation improves oxygenation and reduces respiratory work, thus being beneficial for patients with congestive heart failure. It was not possible to observe statistically significant changes in the hemodynamic data due to the small number of patients and to other associated heart diseases.
de Barros
Ariadne Fernandes
AF
Hospital Estadual Mario Covas, Santo André, SP, Brazil. dinny_fernandes@yahoo.com.br
de Barros
Luciana Costa
LC
Sangean
Márcia Cristina
MC
Vega
Joaquim Minuzo
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012119:Respiration; D016896:Treatment Outcome