Nesiritide has been shown to lower pulmonary artery occlusion pressure and relieve dyspnea in patients with acutely decompensated congestive heart failure (CHF). We retrospectively studied the effects of early nesiritide therapy in patients with severe CHF that required mechanical ventilatory support.
Patients requiring mechanical ventilatory support due to decompensated CHF that were admitted between January 1, 2003 and April 1, 2004 were studied. Patients were stratified into a usual care (UC) group treated with intravenous (IV) diuretics and nitrates versus those treated with an infusion of nesiritide and IV diuretics. Use of beta-blockers, ACE inhibitors, digoxin and spironolactone was allowed in both groups. Patients that were hemodynamically unstable and those with acute myocardial infarctions (MI) were excluded. Left ventricular function was assessed echocardiographycally.
Sixty-three patients were studied; 30 received nesiritide and 33 were treated with nitrates and diuretics. The average age was 79.7 (±8) in both groups. The average ejection fraction was 32% in the UC group versus 30% in the nesiritide group (P=NS). One patient in each group died with an overall mortality of 3.2%. Two patients in the UC group and one patient in the nesiritide group required dialysis. Nesiritide-treated patients had an hourly urine output of 180 mL as compared to 105 mL in the UC group (P=0.05). The net negative fluid balance was 2.4 L in the nesiritide group versus 1.9 L in the UC group (P=0.05). Patients treated with nesiritide were liberated from mechanical ventilation support after 1.6 (±0.8) days versus 2.3 (±0.6) days in the UC group (P=0.05). MICU length of stay was reduced from 3.3 days in the UC group to 2.5 days in the nesiritide group.
The combination of nesiritide and diuretics results in a more rapid diuresis and quicker liberation from mechanical ventilatory support in patients with decompensated CHF.
Early use of nesiritide leads to more rapid resolution of decompensated CHF and decreases MICU length of stay.
R. Moshenyat, None.