Influence of effective noninvasive positive pressure ventilation on inflammatory and cardiovascular biomarkers in stable hypercapnic COPD patients

Abstract

BackgroundNoninvasive positive pressure ventilation (NPPV) using effective pressure levels to reduce chronic hypercapnia improves survival in stable hypercapnic COPD. However, the underlying mechanisms remain unclear. This study investigated the influence of effective NPPV on a panel of cytokines and established cardiovascular biomarkers. MethodsPeripheral blood samples were drawn before and three months after the initiation of NPPV and analyzed by flow cytometric bead array and ELISA. ResultsTwenty COPD patients (forced expiratory volume in 1 s 31 ± 17% predicted) were included. NPPV (inspiratory positive airway pressure 23 ± 4 mbar; breathing frequency 17 ± 2/min) significantly improved arterial carbon dioxide pressure (PaCO2), both during daytime spontaneous breathing (p = 0.005) and nighttime ventilation (p < 0.001). Serum interleukin (IL)-10 levels were slightly reduced (p = 0.016), whereas IL-1 (p = 0.073) and IL-12 (p = 0.089) showed only a tendency towards change over time. Pro-brain natriuretic peptide (proBNP) significantly decreased by a mean of 578 ± 1332 ng/L after three months' NPPV (p = 0.017 vs baseline). No other significant changes in cardiovascular biomarkers occurred. The decrease in PaCO2 during daytime spontaneous breathing was positively correlated with the reduction in proBNP (correlation coefficient 0.613; p = 0.0197). ConclusionEffective NPPV impacts on systemic inflammation in COPD patients. Furthermore, reductions in PaCO2 during NPPV were associated with decreases in proBNP levels. Future studies are needed to clarify these findings in a larger cohort of COPD patients. Clinical trial registrationDRKS00007644 (German Clinical Trials Register; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=resultsExt).