Adaptive servo-ventilation suppresses elevation of C-reactive protein and sympathetic activity in acute uncomplicated type B aortic dissection

Abstract

OBJECTIVES: The aim of this prospective, randomized study was to investigate the effects of adaptive servo-ventilation (ASV), based on haemodynamic parameters, sympathetic status and respiratory conditions in patients with acute uncomplicated type B aortic dissection. METHODS: We enrolled 28 patients with acute uncomplicated type B aortic dissection requiring antihypertensive therapies, who had been admitted within 24 h from onset. Study subjects were randomly assigned either to the ASV group (n = 14) or to the non-ASV group (n = 14). RESULTS: Antihypertensive therapy at an acute phase led to significant reduction in blood pressure in both groups. Heart rate significantly dropped in the ASV group. In the non-ASV group, noradrenaline (746 343 to 912 402 pg/ml, P = 0.033) and dopamine (30 21 to 42 28 pg/ml, P = 0.015) significantly increased at 1 h after admission. Low frequency/high frequency ratios significantly decreased in the ASV group (2.1 1.6 to 1.7 1.1, P = 0.045). During follow-up at the subacute period, pleural effusion significantly increased in the non-ASV group (649 611 vs 190 292%, P = 0.033). Peak C-reactive protein (CRP) had a significant positive correlation with pleural effusion volume (P = 0.039) and was significantly greater in the non-ASV group (15.5 6.3 vs 8.5 6.1 mg/dl, P = 0.009). CONCLUSIONS: In acute type B aortic dissection, ASV was considered to have suppressed the development of sympathetic nervous activity, pleural effusion and elevation of peak CRP.