Cardiopulmonary interactions in patients with heart failure

The purpose of this review was to summarize recent findings concerning the consequences of cardiopulmonary interactions in acute cardiogenic pulmonary edema, weaning from mechanical ventilation and fluid-responsiveness assessment by respiratory variations of stroke volume.

The efficacy of continuous or bilevel positive airway pressure in patients with acute cardiogenic pulmonary edema was strongly suggested by two recent meta-analyses. There is growing evidence to suggest that weaning-induced cardiac dysfunction and acute cardiogenic pulmonary edema could explain a large amount of liberation failure from mechanical ventilation. Despite a potential role for echocardiography and plasma measurements of B-type natriuretic peptide in demonstrating a cardiac origin to weaning failure, the demonstration of a significant increase in pulmonary-artery occlusion pressure during the weaning trial remains the gold standard for this purpose. In patients with heart failure there is no evidence for revisiting the reliability of the respiratory variation of stroke-volume surrogates to predict fluid responsiveness.

For clinical practice, the knowledge of cardiopulmonary interactions is of paramount importance in understanding the crucial role of mechanical ventilation for treating patients with heart failure and, by contrast, the deleterious cardiovascular effects of weaning in patients with overt or hidden cardiac failure.