Department of Pneumology, Sleep and Respiratory Medicine, Hemer Lung Clinic, Hemer, Germany.
Witten/Herdecke University, Witten, Germany.
Respiration. 2018;96(3):240-248. doi: 10.1159/000489228. Epub 2018 Jun 25.
The SERVE-HF study has raised questions concerning the higher mortality under adaptive servoventilation. The ventilatory mode was discussed as a possible aggravating factor.
We wondered if the data recorded by the adaptive servo-ventilation (ASV)-devices in heart failure patients with CSA-CSR ± OSA are different in terms of respiratory parameters and therapeutic pressures compared to patients with CPAP-resistant/emergent-CSA with normal BNP/NT-pro-BNP.
Patients were included, if ASV had normalized respiratory disturbance index in the first night of application and after at least 6 weeks. ASV-device data were analyzed in terms of respiratory rate (RR), min ventilation (MV), endexpiratory (EEP), peak inspiratory pressure (Ppeak) and median pressure.
Compared to CPAP-resistant/emergent-CSA with normal BNP/NT-pro-BNP (n = 25), CSA-CSR- (n = 13) CSA-CSR+OSA-patients (n = 32) with elevated BNP/NT-pro-BNP had higher RR (p < 0.01) in the first night of ASV therapy and during follow-up (15.3 ± 1.3 vs. 17.3 ± 2.4/min) with similar MV (6.5 ± 1.3 vs. 6.6 ± 1.3 L), resulting in significantly lower tidal volumes. EEP (5.6 ± 1.1 vs. 5.5 ± 1.1 hPa), Pmedian and Ppeak (9.8 ± 1.5 vs. 9.7 ± 1.2 hPa) were comparable. Ventilatory parameters were not different between LVEF < 40, 40-49, and ≥50%, neither within the whole group nor the group of CSA-CSR ± OSA and heart failure.
Patients with heart failure and CSA-CSR ± OSA have higher RRs but similar MV under ASV-therapy than patients with CSA and normal BNP. This indicates higher dead space ventilation. EF was not found to have an influence on the ventilatory parameters.
SERVE-HF 研究提出了关于自适应伺服通气下死亡率较高的问题。通气模式被认为是一个可能的加重因素。
我们想知道在心力衰竭合并 CSA-CSR±OSA 患者中，与 CPAP 抵抗/突发 CSA 且 BNP/NT-pro-BNP 正常的患者相比，通过自适应伺服通气（ASV）设备记录的数据在呼吸参数和治疗压力方面是否存在差异。
纳入患者的条件为 ASV 在应用的第一晚和至少 6 周后已将呼吸紊乱指数正常化。分析 ASV 设备的数据，包括呼吸频率（RR）、分钟通气量（MV）、呼气末压（EEP）、吸气峰压（Ppeak）和中压。
与 CPAP 抵抗/突发 CSA 且 BNP/NT-pro-BNP 正常的患者（n=25）相比，CSA-CSR-（n=13）CSA-CSR+OSA 患者（n=32）的 BNP/NT-pro-BNP 升高，ASV 治疗的第一晚和随访期间的 RR 更高（p＜0.01）（15.3±1.3 比 17.3±2.4/min），MV 相似（6.5±1.3 比 6.6±1.3 L），导致潮气量显著降低。EEP（5.6±1.1 比 5.5±1.1 hPa）、Pmedian 和 Ppeak（9.8±1.5 比 9.7±1.2 hPa）无差异。LVEF＜40、40-49 和≥50%的患者之间、整个组、CSA-CSR±OSA 组和心力衰竭组的通气参数均无差异。
心力衰竭合并 CSA-CSR±OSA 的患者在 ASV 治疗下的 RR 高于 CSA 且 BNP 正常的患者，但 MV 相似。这表明死腔通气增加。EF 未发现对通气参数有影响。
