Ventilación mecánica no invasiva intermitente: utilidad en el tratamiento de la insuficiencia cardíaca crónica avanzada

The higher respiratory work and less inspiratory muscle strength of patients with cardiac failure may contribute to dicrease their functional capacity. To assess the effects of non invasive intermittent mechanical ventilation on clinical parameters, peropheral perfusion, cardiac and inspiratory muscle function. Patients with chronic cardiac failure, functional cpacity III-IV were subjected to 6 sessions of nasal non invasive intermittent ventilation during 4 hours or to simulated ventilation (controls). Fifteen ventilated patients and 6 controls completed the protocol. Ventilated patients improved the mahler transition score for dysnea by 4n1.6 points. They also improved their aerobic capacity, increasing the exercise duration from 10.9n4 to 12.7n5 min and their maximal oxygen consumption from 14.6n4 to 16.4n5.7 ml/kg/min. These patients also decreased their O2 and CO2 ventilatory equivalents. Maximal inspiratory pressure increased from 67.9n23.6 to 80.19n21.4 cm H2O, sustained maximal inspiratory pressure increased from 101.4n48 to 133n53 cm H2O and maximal endurance increased from 132n52 to 162n58 g in ventilated patients. None of these variables was modified in control patients. No changes were observed in renal function, blood volume, arterial gases, spirometry or plasma catecholamine levels in any group. Intermittent nasal ventilation or other measures to improve inspiratory muscle function may be beneficial for patients with severe cardiac failure (AU)