Heart-Lung Interaction in Non-Invasive Ventilation: a Narrative Review

Cardiopulmonary interactions represent a complex physiological interplay that becomes critically relevant in patients undergoing mechanical ventilation, particularly with non-invasive modalities. This narrative review explores the pathophysiological basis and clinical implications of heart–lung interactions during non-invasive ventilation (NIV), with a focus on how positive pressure influences biventricular function. We examine how changes in intrathoracic pressure affect right and left ventricular preload and afterload, and how these effects are modulated by ventilation settings, underlying disease states, and ventricular interdependence. Special emphasis is placed on the role of echocardiography as a dynamic tool for assessing hemodynamic status at the bedside. Parameters such as TAPSE, S’ wave, MAPSE, LVOT-VTI, and vena cava indices are discussed in the context of fluid responsiveness, cardiac function, and weaning-induced pulmonary edema (WIPO). The review also addresses the dual role of PEEP—therapeutic when promoting alveolar recruitment, but potentially harmful when leading to RV overload through increased pulmonary vascular resistance. In critically ill patients, understanding and managing heart–lung interactions can be the key to preventing hemodynamic instability. Integrating ultrasound monitoring with tailored ventilatory strategies allows clinicians to better titrate support, minimize cardiovascular compromise, and improve outcomes. This review aims to provide a comprehensive framework for clinicians to interpret and manage heart–lung interactions effectively in the setting of non-invasive respiratory support.