Adaptive servo-ventilation suppresses elevation of C-reactive protein and sympathetic activity in acute uncomplicated type B aortic dissection.
The aim of this prospective, randomized study was to investigate the effects of adaptive servo-ventilation (ASV), based on haemodynamic parameters, sympathetic status and respiratory conditions in patients with acute uncomplicated type B aortic dissection.



We enrolled 28 patients with acute uncomplicated type B aortic dissection requiring antihypertensive therapies, who had been admitted within 24 h from onset. Study subjects were randomly assigned either to the ASV group (n = 14) or to the non-ASV group (n = 14).



Antihypertensive therapy at an acute phase led to significant reduction in blood pressure in both groups. Heart rate significantly dropped in the ASV group. In the non-ASV group, noradrenaline (746 ± 343 to 912 ± 402 pg/ml, P = 0.033) and dopamine (30 ± 21 to 42 ± 28 pg/ml, P = 0.015) significantly increased at 1 h after admission. Low frequency/high frequency ratios significantly decreased in the ASV group (2.1 ± 1.6 to 1.7 ± 1.1, P = 0.045). During follow-up at the subacute period, pleural effusion significantly increased in the non-ASV group (649 ± 611 vs 190 ± 292%, P = 0.033). Peak C-reactive protein (CRP) had a significant positive correlation with pleural effusion volume (P = 0.039) and was significantly greater in the non-ASV group (15.5 ± 6.3 vs 8.5 ± 6.1 mg/dl, P= 0.009).



In acute type B aortic dissection, ASV was considered to have suppressed the development of sympathetic nervous activity, pleural effusion and elevation of peak CRP.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan bassbord1028@yahoo.co.jp.
Arudo
A
Hiraoka
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Kota
K
Suzuki
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Genta
G
Chikazawa
Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Shinsaku
S
Nogami
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Taichi
T
Sakaguchi
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Hidenori
H
Yoshitaka
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000097:blood / Q000150:complications / Q000628:therapy*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000150:complications / Q000628:therapy*; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002097:C-Reactive Protein; D009638:Norepinephrine
Adaptive servo-ventilation; Aorta; Dissection; Sympathetic nervous system