Chest
Clinical Investigations in Critical CareShort-term Noninvasive Pressure Support Ventilation Prevents ICU Admittance in Patients With Acute Cardiogenic Pulmonary Edemaa
Section snippets
Materials and Methods
The setting was the ED of a university hospital. This study was performed in accordance with the Declaration of Helsinki. Informed consent was given by the patients in the study or by their next of kin. All consecutive patients affected by ACPE who required respiratory assistance after the institution of conventional medical treatment (defined as therapy with morphine oxygen via face mask, diuretics, and vasoactive drugs) had proven to be ineffective were eligible for the study.
The inclusion
Results
Between January 1999 and December 2000, 58 consecutive patients with ACPE were enrolled in the study. The underlying diseases were as follows: ischemic heart disease (34 patients); COPD (16 patients); hypertension (15 patients); diabetes (7 patients); chronic renal failure (8 patients); and patent ductus (1 patient). Seven patients (12%) had signs of AMI at the time of hospital admission. Baseline hemodynamic and respiratory parameters, the data for which were collected before the onset of
Discussion
The great majority of patients with ACPE are initially managed in the ED. When patients do not respond to conventional medical treatment, ventilator assistance is needed. We tested the hypothesis that a short NIPSV run in the ED may avoid the use of invasive ventilation and admittance to the ICU. In the present study, critically ill patients were selected by their need for ventilatory support after undergoing ineffective conventional medical therapy for ACPE (eg, morphine, oxygen mask,
Acknowledgment
We thank Luca Bigatello for discussing our results, and Bruno Simini for his precious advice and suggestions in preparing and editing the manuscript.
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2017, Annals of Emergency MedicineCitation Excerpt :Many patients present to the emergency department (ED) with cardiogenic pulmonary edema. In addition to reversing the specific underlying causes, conventional approaches to oxygen and ventilation therapy for these patients include nasal cannula oxygen, or face mask oxygen, noninvasive ventilation, and intubation.1-6 Editor’s Capsule Summary
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Impact of noninvasive ventilation (NIV) trial for various types of acute respiratory failure in the emergency department; decreased mortality and use of the ICU
2009, Respiratory MedicineCitation Excerpt :The application of NIV for other diagnoses is, however, still equivocal and not recommended routinely, although trials using patients with pneumonia,6,7 hypoxic respiratory failure,8 bronchial asthma,9 other types of hypercapnic failure10 and those with do-not-intubate (DNI) orders11,12 suggest its validity. Early use of NIV in the emergency department (ED) was revealed to improve physiological variables rapidly, and reduced mortality, ICU admissions for COPD13 and cardiogenic pulmonary edema.14 Likewise, for other etiologies, the immediate provision of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) can prevent atelectasis and subsequent V/Q mismatch causing poorer oxygenation, while Bilevel-PAP or pressure support can prevent further fatigue of respiratory muscles.
Continuous Positive Airway Pressure Versus Bilevel Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Randomized Multicenter Trial
2007, Annals of Emergency MedicineCitation Excerpt :The duration of ventilation is of major importance, specifically in the setting of the ED, where procedures must be short and effective. Moreover, prolonged noninvasive ventilation may be associated with reduced care to the patient and dangerously delaying unavoidable tracheal intubation and invasive ventilation.32,33 To our knowledge, this is the first multicenter study conducted in the ED that evaluated the use of 2 noninvasive ventilation modes in the treatment of acute cardiogenic pulmonary edema.
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