Respiratory augmentation of left ventricular function during spontaneous ventilation in severe left ventricular...

A patient with severe congestive cardiomyopathy demonstrated involuntary forceful expiratory grunting that was associated with an elevated intrathoracic pressure and stable hemodynamics. Face-mask administration of 20 cm H2O as continuous positive-airway pressure (CPAP) abolished the grunting without hemodynamic compromise. However, loss of CPAP by mask leak resulted in rapid hemodynamic deterioration and resumption of grunting. Endotracheal intubation with 20 cm H2O of positive end-expiratory pressure restored hemodynamic stability. This suggests that spontaneous ventilatory efforts can augment the failing myocardium.