Usefulness of nasal continuous positive airway pressure in acute congestive heart failure infants with pulmonary artery hypertension and congenital heart disease

Abstract

Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH). Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n=32) and the non-nCPAP group (n=28). Data were analyzed, which included lactic acid value (Lac) by arterial blood gas analysis, calculation of oxygenation index [pa(O2)/FiO2], detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level, determination of left ventricular end diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG). Results 1.Comparison of arterial blood gas between the 2 groups: 1 d after treatment, there were significant differences in pa(O2)/FiO2 and Lac between the 2 groups(t=4.743, 5.402, all P 0.05).2.Comparison of index of heart function between the 2 groups: after 3-7 d treatment, LVEDVI, LVEF, and PASP were statistically different between the 2 groups(t=2.052, 2.704, 2.019, all P<0.05).3.Comparison of serum indexes between the 2 groups: 3-7 d after treatment, serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t=9.869, P<0.05).4.Comparison of clinical prognosis between the 2 groups: the differences in needing endobronchial intubation rate, mechanical ventilation time, time in PICU and mortality rate were all statistically significant between the 2 groups(χ2=5.505, P=0.019; t=4.788, P=0.000; t=5.068, P=0.000; χ2=4.284; P=0.038). Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa(O2)/FiO2, reducing left ventricular and right ventricular afterload and improving the left ventricular function. Key words: Congenital heart disease; Pulmonary artery hypertension; Congestive heart failure; Continuous positive airway pressure ventilation