Long-term noninvasive ventilation in patients with chronic hypercapnic respiratory failure: assisting the diaphragm, but threatening the heart?

Purpose of reviewTo summarize and discuss the available studies on the effects of long-term noninvasive ventilation (NIV) on cardiac function in patients with chronic hypercapnic respiratory failure.Recent findingsA total of nine studies investigated the acute and long-term effects of NIV on cardiac performance in patients with chronic hypercapnic respiratory failure.SummaryBoth the application of expiratory airway pressure and (higher) inspiratory pressures may acutely decrease cardiac output during the initiation of NIV. However, the meaning of this effect in the long term is not clear. Apparently, natriuretic peptides decrease after a certain period of NIV use and heart rate variability seems to improve. Probably, a decreased cardiac output might not be disadvantageous and reflects a decreased work of breathing. Furthermore, the hemodynamic effects of long-term NIV are dependent on the underlying cardiac comorbidities. This is important in patients with chronic obstructive pulmonary disease, where cardiac comorbidities are frequent.Considering the available physiological data, future studies should focus on the impact of long-term NIV on heart performance and clinical outcomes. Second, further studies are needed investigating the cardiac long-term effects of different NIV modes, pressures (low and high) and breathing frequencies, especially when underlying cardiac comorbidity is present.