Effects of extrathoracic mechanical ventilation on pulmonary hypertension secondary to lung disease.

Yoko Sato,Toru Kotani,Noriyuki Saeki,Takuma Asakura,Kazutetsu Aoshiba

doi:10.1007/s00540-016-2172-7

Abstract

PurposeBiphasic cuirass ventilation (BCV) is a form of non-invasive extrathoracic positive and negative pressure mechanical ventilation. The present study was conducted to quantify our positive experience using BCV to dramatically improve gas exchange and cardiac function in patients with acute exacerbation of chronic respiratory failure and secondary pulmonary hypertension (PH).MethodsBCV was applied for 2 weeks in 17 patients with PH caused by lung disease. Ventilation sessions were limited to 1 h per day to prevent exhaustion. To assess respiratory and circulatory effects, percutaneous arterial oxygen saturation (SpO2) was measured before and after each daily BCV session, and right heart catheter test [mean pulmonary artery pressure (mPAP), right atrium pressure (RAP), pulmonary artery occlusion pressure (PAOP) and cardiac index (CI)] and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before and after a series of BCV sessions.ResultsSpO2 transiently improved after each BCV session. After a series of BCV, mPAP decreased from 27.2 to 22.4 mmHg (p = 0.0007). PAOP, CI and serum NT-proBNP levels decreased compared with baseline. No patients were treated with epoprostenol, iloprost, bosentan or sildenafil for PH.ConclusionBCV may improve circulatory function in patients with PH caused by lung disease.Electronic supplementary materialThe online version of this article (doi:10.1007/s00540-016-2172-7) contains supplementary material, which is available to authorized users.

Highlights

Structural and functional alterations of pulmonary vessels eventually lead to secondary pulmonary hypertension (PH) and cor pulmonale [1] in patients with chronic lung disease
Long-term oxygen therapy has been effective in improving the physical condition of patients with chronic obstructive pulmonary disease (COPD) and pulmonary artery pressure (PAP)
Based on our experience and observations, we hypothesized that Biphasic cuirass ventilation (BCV) provides better oxygenation than baseline and reduces pulmonary vascular resistance (PVR) in PH caused by chronic lung disease. We examined this hypothesis in patients undergoing BCV as a treatment for PH secondary to lung disease

Summary

Introduction

Structural and functional alterations of pulmonary vessels eventually lead to secondary pulmonary hypertension (PH) and cor pulmonale [1] in patients with chronic lung disease. These alterations are considered to be the end stage of chronic lung disease and the only effective treatment currently available involves supplemental oxygen, diuretics, digitalis and anticoagulants [1,2,3]. Biphasic cuirass ventilation (BCV), a form of non-invasive extrathoracic mechanical ventilation, is an advanced model of the iron lung. BCV remains in clinical use and has been shown to be as effective as non-invasive positive pressure ventilation for avoiding tracheal intubation in COPD patients [10]

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Conclusion