title: The effect of adaptive servo-ventilation on dyspnoea, haemodynamic parameters and plasma catecholamine concentrations in acute cardiogenic pulmonary oedema.
abstract: BACKGROUND
  Adaptive servo-ventilation has a potential sympathoinhibitory effect in acute cardiogenic pulmonary oedema (ACPO).
  
  
  OBJECTIVE
  To evaluate the acute effects of adaptive servo-ventilation in patients with ACPO.
  
  
  METHODS
  Fifty-eight consecutive patients with ACPO were divided into those who underwent adaptive servo-ventilation and those who received oxygen therapy alone as part of their immediate care. Visual analogue scale, vital signs, blood gas data and plasma catecholamine concentrations at baseline and 1 h during emergency care, and subsequent clinical events (death within 30 days, intubation within seven days or between seven and 30 days, and length of hospital stay) were assessed. Pre-matched and post-propensity score (PS)-matched datasets were analysed.
  
  
  RESULTS
  During the first hour of adaptive servo-ventilation, plasma catecholamine concentrations fell significantly (baseline versus 1 h: epinephrine p = 0.003, norepinephrine p < 0.001, dopamine p < 0.001), with falls in blood pressure, heart rate, respiratory rate and pCO2, and rise in HCO3 and pH. In the PS-matched model, visual analogue scale (p = 0.036), systolic blood pressure (from 153.8 ± 30.7 to 133.1 ± 16.3 mmHg; p = 0.025) and plasma dopamine concentration (p = 0.034) fell significantly in the adaptive servo-ventilation group compared with the oxygen therapy alone group. The clinical outcomes between the groups were comparable.
  
  
  CONCLUSIONS
  In patients with ACPO, emergency care using adaptive servo-ventilation attenuated plasma catecholamine concentrations and led to the improvement of dyspnoea, vital signs and acid-base balance, without adversely influencing clinical outcomes. Using adaptive servo-ventilation, rather than standard oxygen alone, may relieve dyspnoea and improve haemodynamic status, possibly by modulating sympathetic nerve activity.
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan snakano@saitama-med.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tanno
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Keiki
authors.initials: K
authors.lastname: Sugi
authors.affiliation: Department of Emergency and Acute Medicine, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Senbonmatsu
authors.affiliation: Department of Cardiology, International Medical Centre, Saitama Medical University, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002395:Catecholamines / Q000097:blood*; D004632:Emergency Medical Services; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D057216:Propensity Score; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002395:Catecholamines
keywords: Acute cardiogenic pulmonary oedema; acute heart failure; adaptive servo-ventilation; non-invasive ventilation; sympathetic nerve activity