Effects of Non-Invasive Ventilation on Cardiac Function in Patients with Acute Respiratory Failure
Abstract
Background: Non-invasive ventilation (NIV) is widely used to treat chronic obstructive pulmonary disease and heart failure. This study investigated its effects on cardiac function in patients with acute respiratory failure due to COVID-19.
Methods: In this observational cross-sectional study, patients admitted to the ICU of Ayatollah Rouhani Hospital, Babol, who required NIV were evaluated. Heart rate, respiratory rate, arterial blood gas parameters (PaO2, pH, lactate), and echocardiographic indices, including the left ventricular ejection fraction (LVEF), E, tricuspid annular plane systolic excursion (TAPSE), and inferior vena cava diameter (IVCD), were recorded before and 15 minutes after NIV initiation. Data were analyzed using SPSS.
Results: 34 patients, 15 (44.1%) men and 19 (55.9%) women, were studied. Their average age was 60.4 ± 12.8 years. NIV significantly improved heart rate, respiratory rate, oxygenation, pH, and lactate levels. Echocardiographic parameters E and TAPSE improved significantly, and IVCD increased compared to baseline.
Conclusion: NIV rapidly improves both respiratory and cardiac function in patients with acute respiratory failure due to COVID-19, serving as a potential alternative to invasive ventilation in selected cases.
[1] Cardoso D. Acute Respiratory Failure. Basic Concepts for Noninvasive Ventilation Approach. InNoninvasive Ventilation Outside Intensive Care Unit: Rationale and Practice 2023. p. 19-25.
[2] Mandelzweig K, Leligdowicz A, Murthy S, Lalitha R, Fowler RA, Adhikari NKJ. Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis. J Crit Care. 2018; 47:310-9.
[3] Seyfi S, Amri P, Mouodi S. New modalities for non-invasive positive pressure ventilation: A review article. Caspian J Intern Med. 2019; 10(1):1-6.
[4] Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration. 2019; 97(1):3-11.
[5] Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest. 1990; 98(2):317-24.
[6] Meduri GU, Conoscenti CC, Menashe P, Nair S. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest. 1989; 95(4):865-70.
[7] Restrick LJ, Fox NC, Braid G, Ward EM, Paul EA, Wedzicha JA. Comparison of nasal pressure support ventilation with nasal intermittent positive pressure ventilation in patients with nocturnal hypoventilation. Eur Respir J. 1993; 6(3):364-70.
[8] Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014; 174(12):1982-93.
[9] Garner DJ, Berlowitz DJ, Douglas J, Harkness N, Howard M, McArdle N, et al. Home mechanical ventilation in Australia and New Zealand. Eur Respir J. 2013; 41(1):39-45.
[10] Navarra SM, Congedo MT, Pennisi MA. Indications for Non-Invasive Ventilation in Respiratory Failure. Rev Recent Clin Trials. 2020; 15(4):251-7.
[11] Wang X, Zhou Q, He Y, Liu L, Ma X, Wei X, et al. Nosocomial outbreak of COVID-19 pneumonia in Wuhan, China. Eur Respir J. 2020; 55(6):2000544.
[12] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-42.
[13] Siegel MD, Hyzy RC. Ventilator management strategies for adults with acute respiratory distress syndrome. UpToDate. 2019.
[14] Fink S. Worst-case estimates for US coronavirus deaths. New York Times. 2020; 13.
[15] World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 25 January 2020. World Health Organization; 2020.
[16] Wu VC, Huang YC, Wang CL, Huang YC, Lin YS, Kuo CF, et al. Association of Echocardiographic Parameter E/e' With Cardiovascular Events in a Diverse Population of Inpatients and Outpatients With and Without Cardiac Diseases and Risk Factors. J Am Soc Echocardiogr. 2023; 36(3):284-94.
[17] Sanchez PA, O'Donnell CT, Francisco N, Santana EJ, Moore AR, Pacheco-Navarro A, et al. Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis. Ann Am Thorac Soc. 2023; 20(10):1465-74.
[18] Cabeleira MT, Anand DV, Ray S, Black C, Ovenden NC, Díaz-Zuccarini V. Comparing physiological impacts of positive pressure ventilation versus self-breathing via a versatile cardiopulmonary model incorporating a novel alveoli opening mechanism. Comput Biol Med. 2024; 180:108960.
[19] Amri Maleh V, Monadi M, Heidari B, Maleh PA, Bijani A. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease. Caspian J Intern Med. 2016; 7(2):99-104.
[20] Navarra SM, Congedo MT, Pennisi MA. Indications for non-invasive ventilation in respiratory failure. Rev Recent Clin Trials. 2020; 15(4):251-7.
[21] Platto S, Wang Y, Zhou J, Carafoli E. History of the COVID-19 pandemic: Origin, explosion, worldwide spreading. Biochem Biophys Res Commun. 2021; 538:14-23.
[22] Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med. 2020; 24(Suppl 1):S61-S81.
[23] Moret Iurilli C, Brunetti ND, Di Corato PR, Salvemini G, Di Biase M, Ciccone MM, et al. Hyperacute Hemodynamic Effects of BiPAP Noninvasive Ventilation in Patients With Acute Heart Failure and Left Ventricular Systolic Dysfunction in Emergency Department. J Intensive Care Med. 2018; 33(2):128-33.
[24] Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020; 108:154262.
[25] Kim TS, Roslin M, Wang JJ, Kane J, Hirsch JS, Kim EJ. BMI as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID-19 in New York. Obesity (Silver Spring). 2021; 29(2):279-84.
[26] Jamil Z, Khalid S, Abbasi SM, Waheed Y, Ahmed J. Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation. Asian Pac J Trop Med. 2021; 14(4):176-82.
[27] Sartini C, Tresoldi M, Scarpellini P, Tettamanti A, Carcò F, Landoni G, et al. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020; 323(22):2338-40.
[28] Dikensoy O, Ikidag B, Filiz A, Bayram N. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract. 2002; 56(2):85-8.
[29] Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004; (3):CD004104.
[30] Busana M, Schiavone M, Lanfranchi A, Battista Forleo G, Ceriani E, Beatrice Cogliati C, et al. Non-invasive hemodynamic profile of early COVID-19 infection. Physiol Rep. 2020; 8(20):e14628.
[31] Hensel M, Strunden MS, Tank S, Gagelmann N, Wirtz S, Kerner T. Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short. Am J Emerg Med. 2019; 37(4):651-6.
[32] Borghi-Silva A, Reis MS, Mendes RG, Pantoni CB, Simões RP, Martins LE, et al. Noninvasive ventilation acutely modifies heart rate variability in chronic obstructive pulmonary disease patients. Respir Med. 2008; 102(8):1117-23.
[33] Giustiniano E, Fazzari F, Bragato RM, Curzi M, Cecconi M. Trans-thoracic Echocardiography in Prone Positioning COVID-19 Patients: a Small Case Series. SN Compr Clin Med. 2020; 2(11):2381-6.
[34] Gaeta AM, D'Andrea A, Mazza M, Annunziata A, di Frega GS, Marotta A, Fiorentino G. Effect of NIV on right heart function assessment by two-dimensional speckle-tracking echocardiography (2D-STE) in patients with OSAS. Eur Respir J. 2015; 46(suppl 59): OA4784.
[35] Li YL, Zheng JB, Jin Y, Tang R, Li M, Xiu CH, et al. Acute right ventricular dysfunction in severe COVID-19 pneumonia. Rev Cardiovasc Med. 2020; 21(4):635-41.
[36] Paternoster G, Bertini P, Innelli P, Trambaiolo P, Landoni G, Franchi F, et al. Right Ventricular Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. 2021; 35(11):3319-24.
[37] Zhang Y, Sun W, Wu C, Zhang Y, Cui L, Xie Y, Wang B, He L, et al. Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients. Front Cardiovasc Med. 2021; 8:641088.
[2] Mandelzweig K, Leligdowicz A, Murthy S, Lalitha R, Fowler RA, Adhikari NKJ. Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis. J Crit Care. 2018; 47:310-9.
[3] Seyfi S, Amri P, Mouodi S. New modalities for non-invasive positive pressure ventilation: A review article. Caspian J Intern Med. 2019; 10(1):1-6.
[4] Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration. 2019; 97(1):3-11.
[5] Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest. 1990; 98(2):317-24.
[6] Meduri GU, Conoscenti CC, Menashe P, Nair S. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest. 1989; 95(4):865-70.
[7] Restrick LJ, Fox NC, Braid G, Ward EM, Paul EA, Wedzicha JA. Comparison of nasal pressure support ventilation with nasal intermittent positive pressure ventilation in patients with nocturnal hypoventilation. Eur Respir J. 1993; 6(3):364-70.
[8] Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014; 174(12):1982-93.
[9] Garner DJ, Berlowitz DJ, Douglas J, Harkness N, Howard M, McArdle N, et al. Home mechanical ventilation in Australia and New Zealand. Eur Respir J. 2013; 41(1):39-45.
[10] Navarra SM, Congedo MT, Pennisi MA. Indications for Non-Invasive Ventilation in Respiratory Failure. Rev Recent Clin Trials. 2020; 15(4):251-7.
[11] Wang X, Zhou Q, He Y, Liu L, Ma X, Wei X, et al. Nosocomial outbreak of COVID-19 pneumonia in Wuhan, China. Eur Respir J. 2020; 55(6):2000544.
[12] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-42.
[13] Siegel MD, Hyzy RC. Ventilator management strategies for adults with acute respiratory distress syndrome. UpToDate. 2019.
[14] Fink S. Worst-case estimates for US coronavirus deaths. New York Times. 2020; 13.
[15] World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 25 January 2020. World Health Organization; 2020.
[16] Wu VC, Huang YC, Wang CL, Huang YC, Lin YS, Kuo CF, et al. Association of Echocardiographic Parameter E/e' With Cardiovascular Events in a Diverse Population of Inpatients and Outpatients With and Without Cardiac Diseases and Risk Factors. J Am Soc Echocardiogr. 2023; 36(3):284-94.
[17] Sanchez PA, O'Donnell CT, Francisco N, Santana EJ, Moore AR, Pacheco-Navarro A, et al. Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis. Ann Am Thorac Soc. 2023; 20(10):1465-74.
[18] Cabeleira MT, Anand DV, Ray S, Black C, Ovenden NC, Díaz-Zuccarini V. Comparing physiological impacts of positive pressure ventilation versus self-breathing via a versatile cardiopulmonary model incorporating a novel alveoli opening mechanism. Comput Biol Med. 2024; 180:108960.
[19] Amri Maleh V, Monadi M, Heidari B, Maleh PA, Bijani A. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease. Caspian J Intern Med. 2016; 7(2):99-104.
[20] Navarra SM, Congedo MT, Pennisi MA. Indications for non-invasive ventilation in respiratory failure. Rev Recent Clin Trials. 2020; 15(4):251-7.
[21] Platto S, Wang Y, Zhou J, Carafoli E. History of the COVID-19 pandemic: Origin, explosion, worldwide spreading. Biochem Biophys Res Commun. 2021; 538:14-23.
[22] Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian J Crit Care Med. 2020; 24(Suppl 1):S61-S81.
[23] Moret Iurilli C, Brunetti ND, Di Corato PR, Salvemini G, Di Biase M, Ciccone MM, et al. Hyperacute Hemodynamic Effects of BiPAP Noninvasive Ventilation in Patients With Acute Heart Failure and Left Ventricular Systolic Dysfunction in Emergency Department. J Intensive Care Med. 2018; 33(2):128-33.
[24] Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020; 108:154262.
[25] Kim TS, Roslin M, Wang JJ, Kane J, Hirsch JS, Kim EJ. BMI as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID-19 in New York. Obesity (Silver Spring). 2021; 29(2):279-84.
[26] Jamil Z, Khalid S, Abbasi SM, Waheed Y, Ahmed J. Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation. Asian Pac J Trop Med. 2021; 14(4):176-82.
[27] Sartini C, Tresoldi M, Scarpellini P, Tettamanti A, Carcò F, Landoni G, et al. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020; 323(22):2338-40.
[28] Dikensoy O, Ikidag B, Filiz A, Bayram N. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract. 2002; 56(2):85-8.
[29] Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004; (3):CD004104.
[30] Busana M, Schiavone M, Lanfranchi A, Battista Forleo G, Ceriani E, Beatrice Cogliati C, et al. Non-invasive hemodynamic profile of early COVID-19 infection. Physiol Rep. 2020; 8(20):e14628.
[31] Hensel M, Strunden MS, Tank S, Gagelmann N, Wirtz S, Kerner T. Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short. Am J Emerg Med. 2019; 37(4):651-6.
[32] Borghi-Silva A, Reis MS, Mendes RG, Pantoni CB, Simões RP, Martins LE, et al. Noninvasive ventilation acutely modifies heart rate variability in chronic obstructive pulmonary disease patients. Respir Med. 2008; 102(8):1117-23.
[33] Giustiniano E, Fazzari F, Bragato RM, Curzi M, Cecconi M. Trans-thoracic Echocardiography in Prone Positioning COVID-19 Patients: a Small Case Series. SN Compr Clin Med. 2020; 2(11):2381-6.
[34] Gaeta AM, D'Andrea A, Mazza M, Annunziata A, di Frega GS, Marotta A, Fiorentino G. Effect of NIV on right heart function assessment by two-dimensional speckle-tracking echocardiography (2D-STE) in patients with OSAS. Eur Respir J. 2015; 46(suppl 59): OA4784.
[35] Li YL, Zheng JB, Jin Y, Tang R, Li M, Xiu CH, et al. Acute right ventricular dysfunction in severe COVID-19 pneumonia. Rev Cardiovasc Med. 2020; 21(4):635-41.
[36] Paternoster G, Bertini P, Innelli P, Trambaiolo P, Landoni G, Franchi F, et al. Right Ventricular Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. 2021; 35(11):3319-24.
[37] Zhang Y, Sun W, Wu C, Zhang Y, Cui L, Xie Y, Wang B, He L, et al. Prognostic Value of Right Ventricular Ejection Fraction Assessed by 3D Echocardiography in COVID-19 Patients. Front Cardiovasc Med. 2021; 8:641088.
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How to Cite
1.
Ghorbanpour M, Ziaie N, Seyfi S, Pourkia R, Amri Maleh P. Effects of Non-Invasive Ventilation on Cardiac Function in Patients with Acute Respiratory Failure. Arch Anesth & Crit Care. 2026;.
