Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Masip, Josep; Figuls, Marta Roqué i; Sanchez, B; Fernàndez, R.; Subirana, Mireia; Expósito, José Ángel

doi:10.1001/jama.294.24.3124

Cited by 525 publications

(280 citation statements)

References 39 publications

(75 reference statements)

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“…[70][71][72][73] This clinical benefit includes improved mortality 70,73 as well as reductions in intubation rate and improvements in physiological parameters (dyspnoea, hypercapnia, acidosis and heart rate). 70, 72 The changes in physiology that contribute to this clinical benefit have been explored but the full picture is incomplete.…”

Section: Effect Of Positive Airway Pressure On Lung Function In Acutementioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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Section: Effect Of Positive Airway Pressure On Lung Function In Acutementioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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“…Studies have generally compared conventional oxygen support systems and NIMV. NIMV is recommended as an initial treatment option for acute COPD exacerbations, acute cardiogenic pulmonary edema, hypoxic respiratory failure in immunosuppressed patients, and for weaning COPD patients from the mechanical ventilation (27)(28)(29)(30). However, the benefit of NIMV in de novo acute hypoxic respiratory failure is not clear.…”

Section: High Flow Nasal Oxygen Therapy In Different Clinical Situatimentioning

confidence: 99%

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

Yıldırım¹,

Öcal²,

Ersoy³

et al. 2017

Eurasian J Pulmonol

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INTRODUCTIONOxygen support therapy should be given to the patients with acute hypoxic respiratory insufficiency in order to provide oxygenation of the tissues until the underlying pathology improves. The inspiratory flow rate requirement of patients with respiratory insufficiency varies between 30 and 120 L/min. Low flow and high flow conventional oxygen support systems produce a maximum flow rate of 15 L/min, and FiO 2 changes depending on the patient's peak inspiratory flow rate, respiratory pattern, the mask that is used, or the characteristics of the cannula. The inability to provide adequate airflow leads to discomfort in tachypneic patients. With high-flow nasal oxygen (HFNO) cannulas, warmed and humidified air matching the body temperature can be regulated at flow rates of 5-60 L/min, and oxygen delivery varies between 21% and 100%. When HFNO, first used in infants, was reported to increase the risk of infection, its long-term use was stopped. This problem was later eliminated with the use of sterile water, and its use has become a current issue in critical adult patients as well. Studies show that HFNO treatment improves physiological parameters when compared to conventional oxygen systems. Although there are studies indicating successful applications in different patient groups, there are also studies indicating that it does not create any difference in clinical parameters, but patient comfort is better in HFNO when compared with standard oxygen therapy and noninvasive mechanical ventilation (NIMV) (1-6). In this compilation, the physiological effect mechanisms of HFNO treatment and its use in various clinical situations are discussed in the light of current studies. The Impact Mechanisms of High Flow Nasal Oxygen TherapyThe HFNO device consists of an air/oxygen mixer, an active heater, a humidifier, a unidirectional inspiratory circuit hose, and a soft nasal cannula that is slightly larger than the standard nasal cannula. AbstractHigh-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures.

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“…[2][3][4][5][6][7][8][9][10]. Despite this background, reports of CPAP application in prehospital setting are, to our knowledge quite limited.…”

Section: Out Of Hospital Use Of Cpapmentioning

confidence: 99%

“…In hospital, non-invasive Continuous Positive Airway pressure (CPAP) has proven effective in ameliorating gas exchange and reducing both the need for endotracheal intubation and the overall mortality of patients with ACPE, as suggested by randomized controlled trials and a recent meta-analysis [2][3][4][5][6][7][8][9][10], although this result has been challenged by a large multicenter trial. [11] With the understanding that immediate advanced medical care is essential to improve the long-term outcome of cardiac patients, we developed a program for the pre-hospital application of CPAP.…”

Section: Introductionmentioning

confidence: 99%

Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

et al. 2008

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PURPOSE: Non invasive Continuous Positive Airway Pressure (CPAP) is effective in reducingintubation rate and mortality of patient with Acute Cardiogenic Pulmonary Edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE. METHODS: In pre-hospital treatment of 62 patients with presumed ACPE, CPAP was added to standard medical treatment while in another 59 patients, CPAP was used as a sole therapy . RESULTS: Helmet CPAP was feasible in all patients. No patient required pre-hospital intubation. In both groups, CPAP significantly improved oxygenation (SpO 2 went from 79 ± 12 % to 97 ± 3% and from 81 ± 13 % to 98 ± 3 %), reduced respiratory rate (from 26 ± 4 to 21 ± 3 bpm and from 30 ± 9 to 22 ± 8 bpm) and improved hemodynamics, with a more pronounced decrease in blood pressure in the group with medical treatment than in the one without it. In the two cohorts, four and five patients were respectively intubated in Emergency Department and eleven and nine eventually died. CONCLUSIONS:Helmet CPAP is feasible, efficient and safe in pre-hospital treatment of presumed ACPE. A significant improvement of physiological variables was observed also in the group treated with CPAP in absence of a drug therapy. We propose helmet CPAP as first line prehospital treatment of presumed severe ACPE.

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Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Abstract: Noninvasive ventilation reduces the need for intubation and mortality in patients with acute cardiogenic pulmonary edema. Although the level of evidence is higher for CPAP, there are no significant differences in clinical outcomes when comparing CPAP vs NIPSV.

Cited by 525 publications

References 39 publications

Heart Failure and the Lung

Heart Failure and the Lung

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

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