There are no investigations so far whether an application of positive pressure during non-invasive ventilation might be a therapeutic option for transudative pleural effusion in patients with heart failure. In view of the pathophysiological process with pleural effusion resulting from an increase in intravascular hydrostatic pressure, non-invasive ventilation might provide an improvement.

The aim of the present study is to investigate whether an additional non-invasive ventilation therapy leads to an improved suppression of pleural effusion in heart failure patients.

Inclusion Criteria:

• Patients admitted to our hospital on a routine or emergency basis
• Patients with heart failure according to the current ESC guidelines and chronic pleural effusion with clinical indication for pleurocentesis
• Non-invasively determined cardiac index of < 2.5 l/min/m²
• BNP > 300 pg/ml
• Transudative pleural effusion according to Light criteria
• Effective pleurocentesis with residual effusion on the side affected of < 500 ml
• Tolerance of non-invasive ventilation without subjective or objective hemodynamic impairment as verified during a test ventilation
• No change in drug or other therapy for the duration of the study (5 days)

Exclusion Criteria:

• Psychological or neurological concomitant disease making an informed consent impossible
• Pregnancy
• Pneumothorax or pneumomediastinum
• Pathologically low blood pressure, particularly associated with intravascular volume depletion
• Liquor discharge, recent head surgery or trauma
• Severe bullous lung disease
• Dehydration
• Current ventilation therapy
• Bilateral pleural effusion > 500 ml at the time of enrolment
• Exudative pleural effusion

Patients with decompensated heart failure and pleural effusion