What are the benefits of noninvasive ventilation (NIV) in the treatment of congestive heart failure (CHF)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print
Answer

Answer

The pathophysiology of respiratory failure in CHF is related to a combination of pulmonary vascular congestion, interstitial edema, and alveolar fluid accumulation. This leads initially to hypoxemic respiratory failure, and patients with CHF who further deteriorate manifest hypercapnic respiratory failure. Positive-pressure ventilation is beneficial because it recruits alveoli, increases functional residual capacity, and allows breathing on the more compliant portion of the lung's pressure-volume curve, thereby decreasing the work of breathing, improving ventilation-perfusion relationships, and eventually correcting hypoxemia and hypercapnia. Positive intrathoracic pressure also decreases preload and left ventricular afterload, both beneficial effects in patients with intravascular volume overload.

These beneficial effects can be achieved with continuous positive airway pressure (CPAP), which has been recommended as a first-line therapy in CHF patients. The other ventilator modalities, such as bilevel positive airway pressure (BiPAP), pressure support ventilation, or volume ventilation, have also been used and some controversy exists regarding their efficacy when compared with CPAP.

Note that CPAP has long been recognized as effective in the management of CHF, with initial reports dating from as early as 1938 using very simple pressure devices. Randomized prospective trials comparing its efficacy with oxygen were not conducted for almost 50 years, and small trials also confirmed its effectiveness in correcting gas exchange abnormalities, even in patients with profound respiratory acidosis, with a general benefit of both a reduction in intubation rates and mortality rates.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!