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Acute hemodynamic effects of adaptive servoventilation in patients with pre-capillary and post-capillary pulmonary hypertension.

Olsson KM, Frank A, Fuge J, Welte T, Hoeper MM, Bitter T - Respir. Res. (2015)

Bottom Line: ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10%, p = 0.01).The hemodynamic effects of ASV were similar in both patient populations.ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, 30623, Hannover, Germany. olsson.karen@mh-hannover.de.

ABSTRACT

Rationale: The hemodynamic effects of adaptive servoventilation (ASV) in patients with pulmonary hypertension (PH) are unknown.

Methods: A series of clinically stable patients with pre- or post-capillary PH underwent ASV therapy (endexpiratory positive airway pressure support 12-14 cm H2O, pressure support 4-10 cm H2O) during right heart catheterization. Hemodynamics were measured at rest, at the end of a 15-min episode of ASV therapy, and 15 min after ASV completion. Hemodynamic variables included heart rate, blood pressure, right atrial pressure (RAP), mean pulmonary artery pressure (PAPm), pulmonary arterial wedge pressure (PAWP), cardiac output and pulmonary vascular resistance (PVR).

Results: The study enrolled 33 patients; 12 patients with post-capillary PH due to heart failure with preserved ejection fraction, and 21 patients with pre-capillary PH due to pulmonary arterial hypertension (n = 8) or chronic thromboembolic pulmonary hypertension (n = 13). ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10%, p = 0.01). Right and left filling pressure increased, while the cardiac output decreased (-0.4 L/min; p < 0.001). The hemodynamic effects of ASV were similar in both patient populations.

Conclusions: ASV had moderate hemodynamic effects in patients with PH of various origins, most importantly a decline in systolic blood pressure, PAPm and cardiac output. ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.

No MeSH data available.


Related in: MedlinePlus

Cardiac output (CO) at baseline and at the end of a 15-min period of adaptive servoventilation in patients with pre-capillary or post-capillary pulmonary hypertension. In the entire group, cardiac output decreased by 0.4 L/min (p < 0.0001). In patients with pre-capillary pulmonary hypertension (PH), cardiac output decreased by 0.5 L/min (p = 0.001). In patients with post-capillary pulmonary hypertension (PH), cardiac output decreased non-significantly by 0.3 L/min (p = 0.11)
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Fig2: Cardiac output (CO) at baseline and at the end of a 15-min period of adaptive servoventilation in patients with pre-capillary or post-capillary pulmonary hypertension. In the entire group, cardiac output decreased by 0.4 L/min (p < 0.0001). In patients with pre-capillary pulmonary hypertension (PH), cardiac output decreased by 0.5 L/min (p = 0.001). In patients with post-capillary pulmonary hypertension (PH), cardiac output decreased non-significantly by 0.3 L/min (p = 0.11)

Mentions: The individual maximum tolerable pressure settings were then applied the next day during right heart catheterization without causing adverse events. Twenty-nine patients (88 %) were ventilated at the highest-pressure settings (maximum EPAP 14 cmH2O, maximum pressure support 10 cmH2O). Hemodynamic effects have been summarized in Table 2. There was an average decline in systolic blood pressure by 8 mmHg (p = 0.01; Fig. 1) while the diastolic blood pressure didn’t change significantly (p = 0.40). The cardiac filling pressures increased (right atrial pressure +2.4 mmHg and PAWP + 3.6 mmHg; both p-values < 0.0001). PAPm decreased by 5 mmHg (p < 0.0001), PVR decreased by 10 % (68 dyn · s · cm−5; p = 0.013) and cardiac output decreased by 0.4 L/min (p < 0.0001). The individual changes in cardiac output are depicted in Fig. 2, which shows that the drop in cardiac output was less consistent in patients with post-capillary PH than in pre-capillary PH. The stroke volume did not change significantly (p = 0.41), while the heart rate declined by 7 beats per minute (p < 0.0001). There was no correlation between the change in PAWP and the change in cardiac output (r = 0.147, p = 0.414). In contrast, the change in cardiac output was inversely related to the change in right atrial pressure (r = −0.414, p = 0.017).Table 2


Acute hemodynamic effects of adaptive servoventilation in patients with pre-capillary and post-capillary pulmonary hypertension.

Olsson KM, Frank A, Fuge J, Welte T, Hoeper MM, Bitter T - Respir. Res. (2015)

Cardiac output (CO) at baseline and at the end of a 15-min period of adaptive servoventilation in patients with pre-capillary or post-capillary pulmonary hypertension. In the entire group, cardiac output decreased by 0.4 L/min (p < 0.0001). In patients with pre-capillary pulmonary hypertension (PH), cardiac output decreased by 0.5 L/min (p = 0.001). In patients with post-capillary pulmonary hypertension (PH), cardiac output decreased non-significantly by 0.3 L/min (p = 0.11)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4634794&req=5

Fig2: Cardiac output (CO) at baseline and at the end of a 15-min period of adaptive servoventilation in patients with pre-capillary or post-capillary pulmonary hypertension. In the entire group, cardiac output decreased by 0.4 L/min (p < 0.0001). In patients with pre-capillary pulmonary hypertension (PH), cardiac output decreased by 0.5 L/min (p = 0.001). In patients with post-capillary pulmonary hypertension (PH), cardiac output decreased non-significantly by 0.3 L/min (p = 0.11)
Mentions: The individual maximum tolerable pressure settings were then applied the next day during right heart catheterization without causing adverse events. Twenty-nine patients (88 %) were ventilated at the highest-pressure settings (maximum EPAP 14 cmH2O, maximum pressure support 10 cmH2O). Hemodynamic effects have been summarized in Table 2. There was an average decline in systolic blood pressure by 8 mmHg (p = 0.01; Fig. 1) while the diastolic blood pressure didn’t change significantly (p = 0.40). The cardiac filling pressures increased (right atrial pressure +2.4 mmHg and PAWP + 3.6 mmHg; both p-values < 0.0001). PAPm decreased by 5 mmHg (p < 0.0001), PVR decreased by 10 % (68 dyn · s · cm−5; p = 0.013) and cardiac output decreased by 0.4 L/min (p < 0.0001). The individual changes in cardiac output are depicted in Fig. 2, which shows that the drop in cardiac output was less consistent in patients with post-capillary PH than in pre-capillary PH. The stroke volume did not change significantly (p = 0.41), while the heart rate declined by 7 beats per minute (p < 0.0001). There was no correlation between the change in PAWP and the change in cardiac output (r = 0.147, p = 0.414). In contrast, the change in cardiac output was inversely related to the change in right atrial pressure (r = −0.414, p = 0.017).Table 2

Bottom Line: ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10%, p = 0.01).The hemodynamic effects of ASV were similar in both patient populations.ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, 30623, Hannover, Germany. olsson.karen@mh-hannover.de.

ABSTRACT

Rationale: The hemodynamic effects of adaptive servoventilation (ASV) in patients with pulmonary hypertension (PH) are unknown.

Methods: A series of clinically stable patients with pre- or post-capillary PH underwent ASV therapy (endexpiratory positive airway pressure support 12-14 cm H2O, pressure support 4-10 cm H2O) during right heart catheterization. Hemodynamics were measured at rest, at the end of a 15-min episode of ASV therapy, and 15 min after ASV completion. Hemodynamic variables included heart rate, blood pressure, right atrial pressure (RAP), mean pulmonary artery pressure (PAPm), pulmonary arterial wedge pressure (PAWP), cardiac output and pulmonary vascular resistance (PVR).

Results: The study enrolled 33 patients; 12 patients with post-capillary PH due to heart failure with preserved ejection fraction, and 21 patients with pre-capillary PH due to pulmonary arterial hypertension (n = 8) or chronic thromboembolic pulmonary hypertension (n = 13). ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10%, p = 0.01). Right and left filling pressure increased, while the cardiac output decreased (-0.4 L/min; p < 0.001). The hemodynamic effects of ASV were similar in both patient populations.

Conclusions: ASV had moderate hemodynamic effects in patients with PH of various origins, most importantly a decline in systolic blood pressure, PAPm and cardiac output. ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.

No MeSH data available.


Related in: MedlinePlus