Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients

Abstract

Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema, but only reduces early 48-h mortality.

Is the noninvasive ventilatory mode of importance during cardiogenic pulmonary edema?

“…No patient required the use of endotracheal intubation in the CPAP arm, whereas 35% of patients in the control group were intubated within 3 h of enrollment. Similar clinical and biological benefits, associated with a drastic decrease of the 48-h mortality rate, were observed in an emergency room multicenter study of elderly patients with severe alveolar hypoventilation [3]. These results were observed and confirmed in various other clinical studies [7][8][9][10].…”

“…Despite its high incidence [1,2] and a high mortality rate after a first episode (20-40%) [3,4], cardiogenic pulmonary edema (CPE) treatment has changed very little during the past 35 years, the only real novelties coming from the proposal for nitrate boluses and the introduction of noninvasive ventilation (NIV). NIV is now routinely used during the emergency care of patients with acute CPE, with the aim of rapidly improving acute respiratory distress symptoms and reducing the need for endotracheal intubation [5].…”

“…Acute hypercapnia is frequently observed in the clinical field [17,18], especially in elderly patients [3], by the combination of respiratory exhaustion and underlying bronchopulmonary diseases. Therefore, at least from a physiological point of view, the best NIV mode should aim to improve clinical signs of respiratory distress, to decrease the inspiratory muscles' workload, and to improve hemodynamics.…”

“…First, the use of NIV during acute respiratory distress is still an issue of importance. Even if outcome parameters improvement is not as important as it was during an initial period when nitrate boluses were not the standard of care [3,17], such respiratory distress and dyspnea lessening should be all clinicians' first goal. Second, even if one considers that the final outcome parameters (mortality, length of stay) are equivalent while using either CPAP or NIPPSV, the shorter resolution time with NIPPSV associated with a more rapid PaCO 2 decrease should favor its use when such a ventilatory mode is available.…”

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

“…Many studies revealed that, CPAP improved arterial oxygenation (PaO 2 ), and reduces endotracheal intubation rate [9][10][11] and mortality rate in ACPE [12,13]. However, other studies failed to show these effects [14][15][16].…”