CARDIOPULMONARY EFFECT OF NASAL CPAP IN INFANTS WITH ACUTE HEART FAILURE SECONDARY TO VENTRICULAR SEPTAL DEFECT

Geng R, Cui W, Jin LZ, Wu JC, Chen XN

Beijing Children’s Hospital, Beijing, P. R. China

Objective: To evaluate the cardiopulmonary effect of nasal CPAP (NCPAP) in children with acute heart failure secondary to ventricular septal defect (VSD).

Methods: Nineteen infants diagnosed of VSD with acute heart failure were sedated and were given 3 to 5cm H₂O NCPAP. Analysis of blood gas was measured at baseline and after 30 minutes on NCPAP. Cardiac function was determined by pulsed Doppler echocardiography in nine infants during the same time.

Results: After NCPAP application , PaO₂/FiO₂ (mean±SD) rose significantly (from 159.97±50.68 to 208.16±74.80mmHg, P<.01). Significant decrease was found in respiratory rate and heart rate (from 62.59±5.51 to 51.76±4.04bpm, 176.59±9.51 to 158.12±4.92bpm respectively, P<.001). PaCO₂ fell but not significantly while on NCPAP (from 55.93±12.75 to 51.04±6.80mmHg). Stroke volume and cardiac output rose significantly (from 10.47±1.80 to 12.11±2.03ml, 1.79±0.28 to1.91±0.29L/min respectively, P<.001). After the transitory cessation of NCPAP, above-mentioned variables were not statistically different from those of baseline.

Conclusion: At the same time of improving oxygenation, NCPAP may offer a new noninvasive adjunct to improving left ventricular function and augmenting cardiac performance in a subset of infants with acute heart failure secondary to VSD.

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