Non-invasive ventilation in cardiogenic pulmonary edema

Bello, Giuseppe; Santis, Paolo De; Antonelli, Massimo

doi:10.21037/atm.2018.04.39

Cited by 34 publications

(14 citation statements)

References 70 publications

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“…Patients presenting with ASHF have been reported to be affected by adverse clinical outcomes such as the possibility of intubation, stroke, malignant arrhythmia, rehospitalization, and unexpected demise [32]. According to the current study, the risk of endotracheal intubation is reduced by nearly half with NIV in comparison with standard therapy, which is in line with the majority of previous studies investigating the benefits of NIV, verifying the success and appropriateness of our therapeutic intervention [8]. Metaanalysis and systematic reviews have found that patients with acute cardiogenic pulmonary edema who were treated immediately with noninvasive ventilation had a 47% reduction in mortality [33,34].…”

Section: Discussionsupporting

confidence: 89%

Efficacy of Non-Invasive Ventilation in Acute Coronary Syndrome Patients with Acute Systolic Heart Failure

Qu¹,

Zhao²,

Cao³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Acute systolic heart failure (ASHF) is one of the most serious complications of the acute coronary syndrome (ACS), and increases the likelihood of adverse clinical outcomes. It remains unclear whether the use of non-invasive ventilation (NIV) could improve symptoms and reduce mortality in patients with ASHF derived from ACS. Methods: Data on biological, clinical, and demographic factors, as well as therapy data, were collected from patients with ASHF in the cardiac department. A total of 1257 ACS patients with ASHF were included in the study. Patients were divided into two groups. The control group received standard oxygen therapy. The comparison group consisted of those who underwent NIV as part of their immediate care. During hospitalization and at follow-up, information on both groups was systematically compared. Results: In comparison with the control group, mean 24-hour urine output was found to be significantly higher in the NIV group. A significant reduction in the duration of symptoms was observed among patients in the NIV group from the time of admission until relief of dyspnea. Heart rate, C-reactive protein, estimated glomerular filtration rate, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was also improved, compared with those in the control group. The NIV group was found to have a higher survival rate. NIV was independently related to all-cause mortality in 1-year follow-up (hazard ratio, 0.674; p = 0.045). Conclusions: Our study shows that NIV, as compared with standard oxygen therapy, has a beneficial impact on heart rate, metabolic balance, and relief of dyspnea in ACS patients with ASHF which results in reduced intubation rate, duration of in-hospital stay, and 1-year mortality.

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Section: Discussionsupporting

confidence: 89%

Efficacy of Non-Invasive Ventilation in Acute Coronary Syndrome Patients with Acute Systolic Heart Failure

Qu¹,

Zhao²,

Cao³

et al. 2022

Rev. Cardiovasc. Med.

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“…The major reason for NIV in this study was cardiac dysfunction, which was characterized by increased work of breathing (35), manifesting as tachypnea with a high respiratory drive. According to the American Thoracic Society guideline (2017), NIV might be used as a ventilatory support for these patients (29).…”

Section: Discussionmentioning

confidence: 81%

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

et al. 2020

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Background: The use of sedation to noninvasive ventilation (NIV) patients remains controversial, however, for intolerant patients who are uncooperative, administration of analgesics and sedatives may be beneficial before resorting to intubation. The aim of this study was to evaluate the efficacy of remifentanil (REM) versus dexmedetomidine (DEX) for treatment of cardiac surgery (CS) patients with moderate to severe NIV intolerance. Methods: This prospective cohort study of CS patients with moderate to severe NIV intolerance was conducted between January 2018 and March 2019. Patients were treated with either REM or DEX, decided by the bedside intensivist. Depending on the treatment regimen, the patients were allocated to one of two groups: the REM group or DEX group. Results: A total of 90 patients were enrolled in this study (52 in the REM group and 38 in the DEX group).The mitigation rate, defined as the percentage of patients who were relieved from the initial moderate to severe intolerant status, was greater in the REM group than DEX group at 15 min and 3 h (15 min: 83% vs. 61%, P=0.029; 3 h: 92% vs. 74%, P=0.016), although the mean mitigation rate (81% vs. 85%, P=0.800) was comparable between the two groups. NIV failure, defined as reintubation or death over the course of study, was comparable between the two groups (19.2% vs. 21.1%, respectively, P=0.831). There were no significant differences between the two groups in other clinical outcomes, including tracheostomy (15.4% vs.15.8%, P=0.958), in-hospital mortality (11.5% vs. 10.5%, P=0.880), ICU length of stay (LOS) (7 vs. 7 days, P=0.802), and in-hospital LOS (17 vs. 19 days, P=0.589). Conclusions: REM was as effective as DEX in CS patients with moderate to severe NIV intolerance.Although the effect of REM was better than that of DEX over the first 3 h, the cumulative effect was similar between the two treatments.

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“…Non-invasive ventilation (NIV) has shown to be beneficial in the treatment of acute respiratory failure associated with acute cardiogenic pulmonary edema, chronic obstructive pulmonary disease and postoperative care, amongst others (Jaber et al, 2010;Osadnik et al, 2017;Bello et al, 2018). These benefits are mainly explained by decreasing the need for intubation and connection to mechanical ventilation (Osadnik et al, 2017;Bello et al, 2018). One of the leading causes of NIV failure is agitation, non-tolerance, and non-cooperative patient, reaching rates of up to 22% (Carlucci et al, 2001).…”

Section: Dex In Non-invasive Ventilationmentioning

confidence: 99%

Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill Patients: Basic and Clinical Approaches

et al. 2020

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Dexmedetomidine (DEX) is a highly selective a2-adrenergic agonist with sedative and analgesic properties, with minimal respiratory effects. It is used as a sedative in the intensive care unit and the operating room. The opioid-sparing effect and the absence of respiratory effects make dexmedetomidine an attractive adjuvant drug for anesthesia in obese patients who are at an increased risk for postoperative respiratory complications. The pharmacodynamic effects on the cardiovascular system are known; however the mechanisms that induce cardioprotection are still under study. Regarding the pharmacokinetics properties, this drug is extensively metabolized in the liver by the uridine diphosphate glucuronosyltransferases. It has a relatively high hepatic extraction ratio, and therefore, its metabolism is dependent on liver blood flow. This review shows, from a basic clinical approach, the evidence supporting the use of dexmedetomidine in different settings, from its use in animal models of ischemia-reperfusion, and cardioprotective signaling pathways. In addition, pharmacokinetics and pharmacodynamics studies in obese subjects and the management of patients subjected to mechanical ventilation are described. Moreover, the clinical efficacy of delirium incidence in patients with indication of non-invasive ventilation is shown. Finally, the available evidence from DEX is described by a group of Chilean pharmacologists and clinicians who have worked for more than 10 years on DEX.

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Non-invasive ventilation in cardiogenic pulmonary edema

Cited by 34 publications

References 70 publications

Efficacy of Non-Invasive Ventilation in Acute Coronary Syndrome Patients with Acute Systolic Heart Failure

Efficacy of Non-Invasive Ventilation in Acute Coronary Syndrome Patients with Acute Systolic Heart Failure

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill Patients: Basic and Clinical Approaches

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