Optimization of pressure settings during adaptive servo-ventilation support using real-time heart rate variability assessment: initial case report

BMC Cardiovascular Disorders

Case Report

Daisuke Nitta¹  Teruhiko Imamura¹  Koichiro Kinugawa² 

[1] Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan;Second Department of Internal Medicine, Toyama University, 2630 Sugitani Toyama-shi, 930-0194, Toyama, Japan;

关键词: Heart failure;    Peak end-expiratory pressure;    Non-invasive positive pressure ventilation;    Case report;   

DOI  :  10.1186/s12872-016-0455-4

 received in 2016-03-29, accepted in 2016-12-22,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAdaptive servo-ventilation (ASV) therapy is a recent non-invasive positive pressure ventilation therapy that was developed for patients with heart failure (HF) refractory to optimal medical therapy. However, it is likely that ASV therapy at relatively higher pressure setting worsens some of the patients’ prognosis compared with optimal medical therapy. Therefore, identification of optimal pressure settings of ASV therapy is warranted.Case presentationWe present the case of a 42-year-old male with HF, which was caused by dilated cardiomyopathy, who was admitted to our institution for evaluating his eligibility for heart transplantation. To identify the optimal pressure setting [peak end-expiratory pressure (PEEP) ramp test], we performed an ASV support test, during which the PEEP settings were set at levels ranging from 4 to 8 mmHg, and a heart rate variability (HRV) analysis using the MemCalc power spectral density method. Clinical parameters varied dramatically during the PEEP ramp test. Over incremental PEEP levels, pulmonary capillary wedge pressure, cardiac index and high-frequency level (reflecting parasympathetic activity) decreased; however, the low-frequency level increased along with increase in plasma noradrenaline concentrations.ConclusionsAn inappropriately high PEEP setting may stimulate sympathetic nerve activity accompanied by decreased cardiac output. This was the first report on the PEEP ramp test during ASV therapy. Further research is warranted to determine whether use of optimal pressure settings using HRV analyses may improve the long-term prognosis of such patients.

【 授权许可】

CC BY   
© The Author(s). 2017