Noninvasive Ventilation in Cardiogenic Pulmonary Edema

Abstract

Studies employing noninvasive pressure support ventilation in cardiogenic pulmonary edema have been performed in the intensive care unit when overt respiratory failure is already present and in small groups of patients. In this multicenter study, performed in emergency departments, 130 patients with acute respiratory failure were randomized to receive medical therapy plus O2 (65 patients) or noninvasive pressure support ventilation (65 patients). The primary end point was the need for intubation; secondary end points were in-hospital mortality and changes in some physiological variables. Noninvasive pressure support ventilation improved PaO2/FIO2, respiratory rate, and dyspnea significantly faster. Intubation rate, hospital mortality, and duration of hospital stay were similar in the two groups. In the subgroup of hypercapnic patients noninvasive pressure support ventilation improved PaCO2 significantly faster and reduced the intubation rate compared with medical therapy (2 of 33 versus 9 of 31; p=0.015). Adverse events, including myocardial infarction, were evenly distributed in the two groups. We conclude that during acute respiratory failure due to cardiogenic pulmonary edema the early use of noninvasive pressure support ventilation accelerates the improvement in PaO2/FIO2, PaCO2, dyspnea, and respiratory rate, but does not affect the overall clinical outcome. Noninvasive pressure support ventilation does, however, reduce the intubation rate in the subgroup of hypercapnic patients.

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

“…All 15 trials from 2000 to 2009 excluded patients with cardiogenic shock. In addition, 9 of these 15 trials, and 8 of the 10 trials in the period 2005 through 2009, also excluded patients who required acute coronary revascularization 48,53,56,61,62,64,65 or who had acute coronary syndrome. 54,59 Hence, it is difficult to extend recommendations to these specific popu lations.…”

Waiting to Exhale: Optimizing Noninvasive Synchrony in COPD?

“…1 NIV has been used successfully in patients with cardiogenic pulmonary edema. [2][3][4] It has been shown to decrease intubation duration and may improve the weaning results in chronic hypercapnic respiratory failure. 5 It has been used successfully in acute hypoxemic respiratory failure, including community-acquired pneumonia and acute chest syndrome.…”

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

“…However, other studies failed to show these effects [14][15][16]. As compared with CPAP, and oxygen therapy, Bi-PAP reduces the work of breathing and improves gas exchange, dyspnea and respiratory distress more effectively [17,18]. However, the role of Bi-PAP in patients with ACPE remains controversial.…”