Non-invasive ventilation in acute cardiogenic pulmonary oedema

Abstract

Non-invasive ventilation (NIV) is the delivery of assisted mechanical ventilation to the lungs, without the use of an invasive endotracheal airway. NIV has revolutionised the management of patients with various forms of respiratory failure. It has decreased the need for invasive mechanical ventilation and its attendant complications. Cardiogenic pulmonary oedema (CPO) is a common medical emergency, and NIV has been shown to improve both physiological and clinical outcomes. From the data presented herein, it is clear that there is sufficiently high level evidence to favour the use of continuous positive airway pressure (CPAP), and that the use of CPAP in patients with CPO decreases intubation rate and improves survival (number needed to treat seven and eight respectively). However, there is insufficient evidence to recommend the use of bilevel positive airway pressure (BiPAP), probably the exception being patients with hypercapnic CPO. More trials are required to conclusively define the role of BiPAP in CPO.

Shearing of a Frova Intubating Introducer by a Bronchocath double lumen tube

“…Secondly, the mean arterial pressure and heart rate after intubation were similar to baseline levels. Again, this is remarkable, as in most previous pressor response studies, both arterial pressure and heart rate following intubation were found to be significantly greater than not only the pre-intubation levels but also the preinduction levels [1,3]. One can only assume that their anaesthetic technique, which included fentanyl 100 lg and isoflurane 2%, considerably attenuated the cardiovascular responses and, indeed, may have contributed to their failure to find differences in the responses to intubation between the two groups.…”

“…Firstly, the mean arterial pressure following Macintosh laryngoscopy actually fell from the baseline level taken immediately before laryngoscopy. This is difficult to understand as it has long been known that Macintosh laryngoscopy alone causes a significant rise in arterial pressure and catecholamine levels [3]. Secondly, the mean arterial pressure and heart rate after intubation were similar to baseline levels.…”

“…Several techniques for placement of DLTs have been described [1][2][3][4]. These frequently involve the use of some type of stylet or bougie, with or without fibreoptic verification.…”

VI. Ventilación no invasiva en pacientes con edema pulmonar agudo cardiogénico

“…Se han publicado nueve revisiones sistemáticas y/o meta-análisis [41][42][43][44][45][46][47][48][49] . La primera revisión sistemáti-ca, publicada en 1998 por Pang y cols 46 , no logró demostrar una reducción significativa de la tasa de intubación ni de la mortalidad al emplear CPAP, pero sólo incluyó tres estudios (n = 179).…”

A reply

“…................................................................................................................................................................................................................. Non-invasive ventilation (NIV) has revolutionised the management of diverse forms of respiratory failure [1]. It decreases the need for tracheal intubation and, in specific instances, also decreases mortality [2,3]. However, the role of NIV in acute neuromuscular respiratory failure is controversial.…”