Key result
Long-term noninvasive ventilation may acutely decrease cardiac output during initiation, but appears to decrease natriuretic peptides and improve heart rate variability over time.
Why the study?
Does long-term noninvasive ventilation affect cardiac function in patients with chronic hypercapnic respiratory failure?
Does long-term noninvasive ventilation affect cardiac function in patients with chronic hypercapnic respiratory failure?
Long-term noninvasive ventilation in chronic hypercapnic respiratory failure may have beneficial long-term effects on cardiac function, such as reducing natriuretic peptides and improving heart rate variability, despite acute decreases in cardiac output.
Warrants monitoring for acute output drop at NIV start; hypothesis-generating for long-term cardiac benefits pending RCTs.
PURPOSE OF REVIEW: To summarize and discuss the available studies on the effects of long-term noninvasive ventilation (NIV) on cardiac function in patients with chronic hypercapnic respiratory failure. RECENT FINDINGS: A total of nine studies investigated the acute and long-term effects of NIV on cardiac performance in patients with chronic hypercapnic respiratory failure. SUMMARY: Both the application of expiratory airway pressure and (higher) inspiratory pressures may acutely decrease cardiac output during the initiation of NIV. However, the meaning of this effect in the long term is not clear. Apparently, natriuretic peptides decrease after a certain period of NIV use and heart rate variability seems to improve. Probably, a decreased cardiac output might not be disadvantageous and reflects a decreased work of breathing. Furthermore, the hemodynamic effects of long-term NIV are dependent on the underlying cardiac comorbidities. This is important in patients with chronic obstructive pulmonary disease, where cardiac comorbidities are frequent.Considering the available physiological data, future studies should focus on the impact of long-term NIV on heart performance and clinical outcomes. Second, further studies are needed investigating the cardiac long-term effects of different NIV modes, pressures (low and high) and breathing frequencies, especially when underlying cardiac comorbidity is present.
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Duiverman et al. (2015) conducted a review in Chronic hypercapnic respiratory failure. Long-term noninvasive ventilation (NIV) was evaluated on Cardiac function and performance. Long-term noninvasive ventilation may acutely decrease cardiac output during initiation, but appears to decrease natriuretic peptides and improve heart rate variability over time.
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