Assistert ventilasjon av hjertesviktpasienter med Cheyne-Stokes respirasjon. : Hva sier forskningen?

Abstract

Heart failure is a serious diagnosis that, in spite of more intensive treatment over the last decades, still has a bad prognosis. Cheyne-Stokes respiration (CSR), a pathologic breathing pattern, is shown to be present in 30-40 % of patients with heart failure. CSR gives central sleep apnoea, recurrent episodes of hypoxia and elevated levels of sympathetic activation. Patients with heart failure and CSR have a higher risk of morbidity and mortality than those without CSR. Over the last 15 years articles about how to reduce CSR by using different modes of assisted ventilation have been published. I have done a review of ten of these articles, assessing effect on CSR, cardiac function, sleep disorder and quality of life. The different modes of assisted ventilation described in these articles are: Continuous positive airway pressure (CPAP), Bi-level continuous airway pressure (BiPAP), High-frequency jet ventilation (HFJV), Adaptive servo-ventilation (ASV) and oxygen therapy. All of them reduce the amount CSR. All of them reduce arousals from sleep. To some extent they improve cardiac function. Improvement in quality of life has been more difficult to prove. Although CPAP is the most studied mode of assisted ventilation, a quite new and advanced mode of ventilator (ASV) has documented the best results, so far. In the future, long-term studies with larger number of patients will be needed to determine what role assisted ventilation should have in the treatment of heart-failure patients with CSR.