Meta-analysis: Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Weng, Cui-Lian; Zhao, Yun-Tao; Liu, Qinghua; Fu, C.; Sun, Feng; Ma, Yanliang; Chen, Yanwen; He, Quan-Ying

doi:10.7326/0003-4819-152-9-201005040-00009

Cited by 223 publications

(126 citation statements)

References 42 publications

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“…[2][3][4][5][6] NIV is also used for managing respiratory symptoms associated with acute cardiogenic pulmonary edema, and minimizes SEE THE RELATED EDITORIAL ON PAGE 303 the need for intubation in these patients. 7 Investigators have also used NIV in asthma, pneumonia, neuromuscular disease, post-extubation, and hypoxemic and postoperative acute respiratory failure, with varying success. [8][9][10][11][12][13][14][15] The timing and location of initiation of NIV has been evaluated by investigators.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

et al. 2013

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BACKGROUND: Initiation of noninvasive ventilation (NIV) on the wards is not universally accepted. Medical emergency teams (METs) provide acute care and monitoring to deteriorating patients on the general wards. Whether it is safe for an MET to start NIV in ward patients with respiratory distress remains unclear. METHODS: We evaluated 1,123 MET calls in 30,217 ward patients between January 2009 and June 2011 from the prospectively maintained MET database in our tertiary care hospital. We identified ward patients with acute desaturation (< 90%) and tachypnea (breathing frequency > 28 breaths/min), for whom an MET was called. Subjects transferred to the ICU at the end of an MET call were excluded. The remaining ward subjects were divided into 2 groups: patients who were not started on NIV by the MET; versus patients who were started on NIV by the MET. The primary outcome was endotracheal intubation or ICU transfer within 48 hours of MET activation. Secondary outcome measures were 28-day mortality and ICU mortality. RESULTS: Two hundred thirty-eight MET subjects met the study criteria, and 109 immediate ICU transfers were excluded. Of the remaining 129 ward subjects, 54 were in the NIV group, and 75 in the no-NIV group. The NIV group subjects were sicker (mean Acute Physiology and Chronic Health Evaluation II score 17.6 ؎ 5.1 versus 14.4 ؎ 5, P < .001). Subjects with pulmonary edema, COPD exacerbation, or asthma exacerbation were more likely, while those with pneumonia were less likely to be placed on NIV. The primary outcome was reached in 2/54 (3.7%) of the NIV subjects and 12/75 (16%) of the no-NIV subjects (P ‫؍‬ .03). There was no significant difference (P > .30) between the groups in 28-day mortality (7.4% vs 13.3%) or ICU mortality (3.7% vs 8%). CONCLUSIONS: In selected ward patients, especially those with COPD or pulmonary edema, NIV can be safely initiated by an MET.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

et al. 2013

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“…Similarly, for acute cardiogenic pulmonary edema there is a significant reduction in the intubation rate with NIV (risk ratio 0.54, 95% CI 0.33-0.86). 8 Although more patients (10%) are intubated with usual medical care, still 5% of patients required intubation despite the use of NIV. A prospective observational study of NIV use in France reported a 38% failure rate in a mixed population of patients with acute respiratory failure.…”

Section: The Problemmentioning

confidence: 99%

“…A number of narrative and systematic reviews have been written on this subject. [1][2][3][4][5][6][7][8] For some conditions, such as exacerbation of COPD or acute cardiogenic pulmonary edema, the use of NIV is considered first-line therapy and standard of care. In fact, an entire RESPIRATORY CARE Journal Conference was recently devoted to this subject.…”

Section: Introductionmentioning

confidence: 99%

Patient-Ventilator Interaction During Noninvasive Ventilation

Hess

2011

Respir Care

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There is arguably more evidence to support the use of noninvasive ventilation (NIV) than any other practice related to the care of patients with acute respiratory failure. Despite this strong evidence base, NIV seems to be under-utilized and the failure rate (need for intubation) may be as high as 40%. Some of these failures potentially relate to asynchrony, although the relationship between asynchrony and NIV failure has not been well studied. Good NIV tolerance has been associated with success of NIV, and improved comfort has been associated with better synchrony. In one study a high rate of asynchrony occurred in 43% of patients during NIV. Asynchrony is commonly associated with leaks. Thus, reducing the leak related to the interface and using a ventilator with good leak compensation should reduce the rate of asynchrony. Asynchronies can also be related to the underlying disease process. This paper reviews issues related to asynchrony during NIV and suggests strategies that might be used to correct asynchrony when it occurs.

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“…Some patients do not tolerate the mask due to claustrophobia or other causes, and nasal bridge skin breakdown can occur and difficult the use of NIV. Non-invasive ventilation is now considered as a firstline intervention in selected patients with severe exacerbation of chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure (4,5), and those affected of acute cardiogenic pulmonary oedema (CPO) (6). Immunosuppressed patients have poor outcome when they develop pulmonary infiltrates and hypoxemic ARF; in these patients, NIV seems to decrease the needs for intubation and the related morbidity and mortality (7,8).…”

Section: Introductionmentioning

confidence: 99%

The art and science of non-invasive ventilation

Ferrer¹

2014

sob

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SummaryNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). NIV is considered a standard of care for the management of hypercapnic ARF in patients with acute exacerbation of chronic obstructive pulmonary disease. With an appropriate selection of patients, NIV can reduce the need for invasive mechanical ventilation, mortality and length of stay. Patients with severe hypoxemic ARF have in general a lower likelihood to need tracheal intubation when NIV as a support for ARF is added to the standard medical treatment. However, the effects of NIV on mortality are less evident, and the heterogeneity of the different published studies suggests that the efficacy may be different among different populations. The optimal time for intubation after NIV failure remains a challenging issue due to increasing evidences on the relationship between delayed intubation and excess mortality in these populations. In intubated patients with preexisting lung disease, the use of NIV in order to advance extubation during difficult and prolonged weaning can result in reduced periods of endotracheal intubation, complication rates and improved survival. Moreover, NIV immediately after extubation is effective in avoiding respiratory failure after extubation and improving survival in patients at risk for this complication, particularly those with chronic respiratory disorders, cardiac co-morbidity, and hypercapnic respiratory failure.KEY WORDS: non-invasive ventilation, acute respiratory failure, weaning, hypoxemic respiratory failure, hypercapnic respiratory failure. IntroductionNon-invasive ventilation (NIV) is one of the most relevant recent advances in the management of patients with severe acute respiratory failure (ARF). Non-invasive ventilation is ventilatory support through the upper airways of patients with an interface, usually a mask; therefore, tracheal intubation or a tracheostomy is not needed. The benefits of NIV appear to be the consequence of avoiding tracheal intubation and the associated morbidity and mortality (1, 2). There are several potential advantages for the use of NIV. Some patients can be managed out of an intensive care unit (ICU), a particularly stressful environment, with additional benefits in reducing the occupation of ICU beds and related costs. Ventilatory support can be intermittent and therefore withdrawal of NIV can be gradual. These patients can cooperate in respiratory therapy; they can receive nebulised therapy, expectorate and communicate with staff and their relatives. However, there are limitations for NIV. Unnecessary delay in intubation of those patients who fail with NIV treatment is associated with worse outcome (3). Some patients do not tolerate the mask due to claustrophobia or other causes, and nasal bridge skin breakdown can occur and difficult the use of NIV. Non-invasive ventilation is now considered as a firstline intervention in selected patients with severe exacerbation of chronic obstructive...

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Meta-analysis: Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Abstract: None.

Cited by 223 publications

References 42 publications

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

Outcomes of Patients Treated With Noninvasive Ventilation by a Medical Emergency Team on the Wards

Patient-Ventilator Interaction During Noninvasive Ventilation

The art and science of non-invasive ventilation

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