Positive pressure ventilation in the management of acute and chronic cardiac failure: A systematic review and meta-analysis

Sunil Nadar, Neeraj Prasad, Rod S. Taylor, Gregory Y.H. Lip*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

52 Citations (Scopus)


Chronic heart failure (CHF) is a common condition and is associated with excess morbidity and mortality, in spite of the many advances in its treatment. Chronic stable heart failure is also associated with an increased incidence of sleep-related breathing disorders, such as central sleep apnoea (CSA) and Cheyne Stokes respiration (CSR). Continuous positive airways pressure (CPAP) has been shown to alleviate the symptoms of CHF, improve left ventricular function and oxygenation. To a certain extent, CPAP also abolishes sleep-related breathing disorders in patients with chronic heart failure. In patients with acute pulmonary oedema, the use of positive pressure ventilation improves cardiac haemodynamic indices, as well as symptoms and oxygenation, and is associated with a lower need for intubation. However, some studies have cast doubts about its safety and suggest a higher rate of myocardial infarction associated with its use. In our opinion, non-invasive positive pressure ventilation and CPAP offers an adjunctive mode of therapy in patients with acute pulmonary oedema and chronic heart failure, who may not be suitable for intubation and in those not responsive to conventional therapies. Non-invasive ventilation also helps to improve oxygenation in those patients with exhaustion and respiratory acidosis. Many trials are still ongoing and the results of these studies would throw more light on the present role of non-invasive ventilation in the management of CHF.

Original languageEnglish
Pages (from-to)171-185
Number of pages15
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - Mar 18 2005
Externally publishedYes


  • Heart failure
  • Positive pressure ventilation
  • Pulmonary oedema

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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