Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Abstract

Noninvasive mechanical ventilation is the recommended first-line method of ventilator support in patients with acute respiratory failure due to cardiogenic pulmonary edema. The main benefits of positive airway pressure in cardiogenic pulmonary edema are: Reduce left and right ventricular output, decrease cardiac output and reduce blood pressure. CPAP might be considered the preferred intervention, as it is easy-to-use, cheap and simple to set up, also in clinical settings different from the ICU. In patients with acute CPE, a growing body of evidence supports the use of noninvasive respiratory assistance as a first line intervention. Bilevel NIV has the potential advantage over CPAP of assisting the patient during inspiration, with relief of dyspnea. However, the actual importance of these advantages of CPAP over bilevel NIV in patients with ARF due to CPE has not been confirmed. In pressure-targeted ventilation, low pressure should be initially delivered to enhance patient’s tolerance. If necessary, these can be gradually increased, as tolerated, to deliver adequate tidal volumes (6-8 mL/kg predicted body weight), relieve dyspnea, reduce respiratory rate and ensure good patient-ventilator interaction. When PSV is delivered, some forms of patient-ventilator asynchrony may occur, causing breathing discomfort. In selecting the optimal ventilator setting, the caregiver should take into account the type of interface used to deliver NIV with a view to facilitating patient-ventilator interaction.