F Lenique, M Habis, F Lofaso, JL Dubois-Rande, A Harf and L Brochard
Physiology Departement, INSERM U296, Henri-Mondor Hospital, Creteil, France.

The ventilatory and hemodynamic effects of continuous positive airway pressure (CPAP) delivered via a face mask (at 0, 5, and 10 cm H2O, and after a return to 0 cm H2O) were studied in nine patients with acute left heart failure (pulmonary artery occlusion pressure [PAOP] > or = 18 mm Hg, and cardiac index [CI] < or = 2.8 L/min/m2). CPAP at 10 cm H2O induced an improvement in lung compliance (60 +/- 10 ml/cm H2O to 87 +/- 20 ml/cm H2O, p < 0.05) and in lung and airway resistance (5.7 +/- 1.0 cm H2O/L/s to 3.4 +/- 1.0 cm H2O/L/s, p < 0.05), a reduction in work of breathing (18 +/- 3 J/min to 12 +/- 2 J/min, p < 0.05), and in the pressure-time index of the respiratory muscles (279 +/- 22 cm H2O/s/min to 174 +/- 25 cm H2O/s/min, p < 0.05), without significant changes in breathing pattern. Despite a significant reduction in the negative swings in intrathoracic pressure (15.2 +/- 1.9 cm H2O to 10.8 +/- 1.8 cm H2O, p < 0.001), no significant change was observed in CI or stroke volume during CPAP. However, mean transmural filling pressures decreased significantly with CPAP, suggesting a better cardiac performance. Neither the level of stroke volume nor of PAOP, was predictive of changes in CI or in stroke volume. In patients with respiratory insufficiency caused by congestive heart failure (CHF), CPAP reduces respiratory muscle effort without altering cardiac output. The slight decrease in mean transmural left and right atrial pressures suggests an improvement in cardiac performance.

This article has been cited by other articles:

				P. Plaisance, R. Pirracchio, C. Berton, E. Vicaut, and D. Payen A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects Eur. Heart J., December 1, 2007; 28(23): 2895 - 2901. [Abstract] [Full Text] [PDF]

				G. Ferrari, F. Olliveri, G. De Filippi, A. Milan, F. Apra, A. Boccuzzi, M. Converso, and P. Navalesi Noninvasive Positive Airway Pressure and Risk of Myocardial Infarction in Acute Cardiogenic Pulmonary Edema: Continuous Positive Airway Pressure vs Noninvasive Positive Pressure Ventilation Chest, December 1, 2007; 132(6): 1804 - 1809. [Abstract] [Full Text] [PDF]

				S. Jelic and T. H. Le Jemtel Diagnostic Usefulness of B-Type Natriuretic Peptide and Functional Consequences of Muscle Alterations in COPD and Chronic Heart Failure. Chest, October 1, 2006; 130(4): 1220 - 1230. [Abstract] [Full Text] [PDF]

				C Philippe, M Stoica-Herman, X Drouot, B Raffestin, P Escourrou, L Hittinger, P-L Michel, S Rouault, and M-P d'Ortho Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period Heart, March 1, 2006; 92(3): 337 - 342. [Abstract] [Full Text] [PDF]

				E. L'Her, N. Deye, F. Lellouche, S. Taille, A. Demoule, A. Fraticelli, J. Mancebo, and L. Brochard Physiologic Effects of Noninvasive Ventilation during Acute Lung Injury Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1112 - 1118. [Abstract] [Full Text] [PDF]

				R Agarwal, A N Aggarwal, D Gupta, and S K Jindal Non-invasive ventilation in acute cardiogenic pulmonary oedema Postgrad. Med. J., October 1, 2005; 81(960): 637 - 643. [Abstract] [Full Text] [PDF]

				D. Kindgen-Milles, E. Muller, R. Buhl, H. Bohner, D. Ritter, W. Sandmann, and J. Tarnow Nasal-Continuous Positive Airway Pressure Reduces Pulmonary Morbidity and Length of Hospital Stay Following Thoracoabdominal Aortic Surgery Chest, August 1, 2005; 128(2): 821 - 828. [Abstract] [Full Text] [PDF]

				K. Bendjelid, N. Schutz, P. M. Suter, G. Fournier, D. Jacques, S. Fareh, and J.-A Romand Does Continuous Positive Airway Pressure by Face Mask Improve Patients With Acute Cardiogenic Pulmonary Edema Due to Left Ventricular Diastolic Dysfunction? Chest, March 1, 2005; 127(3): 1053 - 1058. [Abstract] [Full Text] [PDF]

				S D Crane, M W Elliott, P Gilligan, K Richards, and A J Gray Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema Emerg. Med. J., March 1, 2004; 21(2): 155 - 161. [Abstract] [Full Text] [PDF]

				A. D. Bersten Noninvasive Ventilation for Cardiogenic Pulmonary Edema: Froth and Bubbles? Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1406 - 1408. [Full Text] [PDF]

				L. Brochard Mechanical ventilation: invasive versus noninvasive Eur. Respir. J., November 16, 2003; 22(47_suppl): 31S - 37s. [Abstract] [Full Text] [PDF]

				F. Laghi and M. J. Tobin Disorders of the Respiratory Muscles Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 10 - 48. [Abstract] [Full Text] [PDF]

				C.A. Kelly, D.E. Newby, T.A. Mcdonagh, T.W. Mackay, J. Barr, N.A. Boon, H.J. Dargie, and N.J. Douglas Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. Effects on plasma brain natriuretic peptide concentrations Eur. Heart J., September 1, 2002; 23(17): 1379 - 1386. [Abstract] [Full Text] [PDF]

				L. Brochard Noninvasive Ventilation for Acute Respiratory Failure JAMA, August 28, 2002; 288(8): 932 - 935. [Full Text] [PDF]

				A. de La Chapelle, S. Benoit, M. Bouregba, M. Durand-Reville, and M. Raucoules-Aime The Treatment of Severe Pulmonary Edema Induced by Beta Adrenergic Agonist Tocolytic Therapy with Continuous Positive Airway Pressure Delivered by Face Mask Anesth. Analg., June 1, 2002; 94(6): 1593 - 1594. [Abstract] [Full Text] [PDF]

				K. Bendjelid, P. M. Suter, J.-A. Romand, C. Delclaux, and L. Brochard Treatment of Respiratory Failure With Noninvasive Continuous Positive Airway Pressure JAMA, February 21, 2001; 285(7): 880 - 881. [Full Text] [PDF]

				S Heindl, C Dodt, M Krahwinkel, G Hasenfuss, and S Andreas Short term effect of continuous positive airway pressure on muscle sympathetic nerve activity in patients with chronic heart failure Heart, February 1, 2001; 85(2): 185 - 190. [Abstract] [Full Text]

				C. Delclaux, E. L'Her, C. Alberti, J. Mancebo, F. Abroug, G. Conti, C. Guerin, F. Schortgen, Y. Lefort, M. Antonelli, et al. Treatment of Acute Hypoxemic Nonhypercapnic Respiratory Insufficiency With Continuous Positive Airway Pressure Delivered by a Face Mask: A Randomized Controlled Trial JAMA, November 8, 2000; 284(18): 2352 - 2360. [Abstract] [Full Text] [PDF]

				B. Acosta, R. DiBenedetto, A. Rahimi, M. F. Acosta, O. Cuadra, A. Van Nguyen, and L. Morrow Hemodynamic Effects of Noninvasive Bilevel Positive Airway Pressure on Patients With Chronic Congestive Heart Failure With Systolic Dysfunction Chest, October 1, 2000; 118(4): 1004 - 1009. [Abstract] [Full Text] [PDF]

				B. MAITRE, S. JABER, S. M. MAGGIORE, E. BERGOT, J. C. RICHARD, H. BAKTHIARI, B. HOUSSET, G. BOUSSIGNAC, and L. BROCHARD Continuous Positive Airway Pressure during Fiberoptic Bronchoscopy in Hypoxemic Patients . A Randomized Double-Blind Study Using A New Device Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 1063 - 1067. [Abstract] [Full Text]

				D. D. Sin, A. G. Logan, F. S. Fitzgerald, P. P. Liu, and T. D. Bradley Effects of Continuous Positive Airway Pressure on Cardiovascular Outcomes in Heart Failure Patients With and Without Cheyne-Stokes Respiration Circulation, July 4, 2000; 102(1): 61 - 66. [Abstract] [Full Text] [PDF]

				D. Kindgen-Milles, R. Buhl, A. Gabriel, H. Bohner, and E. Muller Nasal Continuous Positive Airway Pressure: A Method to Avoid Endotracheal Reintubation in Postoperative High-risk Patients With Severe Nonhypercapnic Oxygenation Failure Chest, April 1, 2000; 117(4): 1106 - 1111. [Abstract] [Full Text] [PDF]

				S. MEHTA, P. P. LIU, F. S. FITZGERALD, Y. K. ALLIDINA, and T. DOUGLAS BRADLEY Effects of Continuous Positive Airway Pressure on Cardiac Volumes in Patients with Ischemic and Dilated Cardiomyopathy Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 128 - 134. [Abstract] [Full Text]

				J. M. Poponick, J. P. Renston, R. P. Bennett, and C. L. Emerman Use of a Ventilatory Support System (BiPAP) for Acute Respiratory Failure in the Emergency Department Chest, July 1, 1999; 116(1): 166 - 171. [Abstract] [Full Text] [PDF]

				K.G. van Houwelingen, R. van Uffelen, and A.C.M. van Vliet The sleep apnoea syndromes Eur. Heart J., June 2, 1999; 20(12): 858 - 866. [PDF]

				R. Tkacova, F. Rankin, F. S. Fitzgerald, J. S. Floras, and T. D. Bradley Effects of Continuous Positive Airway Pressure on Obstructive Sleep Apnea and Left Ventricular Afterload in Patients With Heart Failure Circulation, November 24, 1998; 98(21): 2269 - 2275. [Abstract] [Full Text] [PDF]

				J. L Kiely, P. Deegan, A. Buckley, P. Shiels, B. Maurer, and W. T McNicholas Efficacy of nasal continuous positive airway pressure therapy in chronic heart failure: importance of underlying cardiac rhythm Thorax, November 1, 1998; 53(11): 957 - 962. [Abstract] [Full Text]

				M T Naughton Pathophysiology and treatment of Cheyne-Stokes respiration Thorax, June 1, 1998; 53(6): 514 - 518. [Full Text]