Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema

Vital, Flávia Mr; Saconato, Humberto; Ladeira, Magdaline T; Sen, Ayan; Hawkes, Claire; Soares, Bernardo; Burns, Karen E. A.; Atallah, Álvaro Nagib

doi:10.1002/14651858.cd005351.pub2

Cited by 90 publications

(64 citation statements)

References 113 publications

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“…3 Continuous positive airway pressure (CPAP) is a form of non-invasive ventilation (NIV) that has been demonstrated to be a useful adjunct in the management of ACPE and various forms of respiratory failure in the hospital setting. [4][5][6] As with other forms of NIV, CPAP results in faster clinical improvement and can reduce the requirement for invasive ventilation that increases the risk of complications, including nosocomial infections (pneumonia, sinusitis) and tracheal injury, which prolong intensive care unit (ICU) stay and hospital stay. 2,7,8 A growing body of research has recently explored the application of this intervention in the prehospital setting, and there is some evidence to support a benefit in regard to morbidity, mortality, and cost.…”

Section: Introductionmentioning

confidence: 99%

“…2,7,8 A growing body of research has recently explored the application of this intervention in the prehospital setting, and there is some evidence to support a benefit in regard to morbidity, mortality, and cost. 2,6,9 Barriers to the early adoption of prehospital CPAP were largely due to limitations in technology, money, and training. Although the adoption of this modality has increased to include most systems, the overwhelming management for these diseases has been the use of symptom relief drugs and traditional ventilatory support using high-flow demand oxygen devices (non-rebreather) and ventilatory assistance using BVM.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Willmore

Dionne

Maloney

et al. 2015

CJEM

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Background: Continuous positive airway pressure (CPAP) is commonly used in the treatment of acute cardiogenic pulmonary edema (ACPE) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In-hospital evidence is robust: CPAP has been shown to improve respiratory status and to reduce intubation rates. There is less evidence on prehospital CPAP, although the emergency medical services (EMS) adoption of this modality is increasing. The objectives of this study were to 1) measure the effectiveness of prehospital CPAP on morbidity, mortality, and transport times; and 2) audit the selection of patients by medics for appropriateness and safety. Methods: We conducted a before-and-after study from August 1 to October 31 in 2010 and 2011, before and after the implementation of prehospital CPAP in a city of one million people with large rural areas. Medics were trained to apply CPAP to patients with respiratory distress and a presumed diagnosis of ACPE or AECOPD. Charts were selected using the search criteria of the chief complaint of shortness of breath, emergent transport to hospital, and any patients receiving CPAP in the field. Data extracted from ambulance call reports and hospital records were analysed with appropriate univariate statistics. Results: A total of 373 patients enrolled (186 pre-non-invasive ventilation [NIV] and 187 post-NIV), mean age 71.5 years, female 51.4%, and final diagnoses of ACPE 18.9%, AECOPD 21.9%. In the post group of 84 patients meeting NIV criteria, 41.6% received NIV; and of 102 patients not meeting the criteria, 5.2% received NIV. There were 12 minor adverse events in 36 applications (33.3%) as per protocol. Comparing post versus pre, there were higher rates of emergency department (ED) NIV (20.0% v. 13.4%, p < 0.0001) and higher overall mortality (18.8% v. 14.9%, p < 0.0001). There were no differences in ED intubation (2.1% v. 2.3%, p < 0.001) and length of stay (6.8 v. 8.7 days, p = 0.24). Conclusion: Despite the robust in-hospital data supporting its use, we could not find benefit from CPAP in our prehospital

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Willmore

Dionne

Maloney

et al. 2015

CJEM

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“…[1][2][3][4] However, some patients fail to see an improvement in their acute respiratory failure because of NIV failure, and are intubated. Previous studies have reported that NIV intolerance is one of the causes for intubation, [5][6][7][8][9][10][11] and one of the studies 8 has shown that poor NIV tolerance is associated with higher intubation rates.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

et al. 2015

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BACKGROUND: Noninvasive ventilation (NIV) intolerance is one reason for NIV failure. However, the characteristics, predictors, and outcomes of NIV intolerance are unclear. METHODS: A prospective observational study was performed in the respiratory intensive care unit of a teaching hospital. Subjects with acute respiratory failure who used NIV were enrolled. Initially, continuous use of NIV was encouraged. However, if the subject could not tolerate NIV, it was used intermittently. NIV intolerance was defined as termination of NIV due to subject refusal to receive it because of discomfort, even after intermittent use was attempted. RESULTS: A total of 961 subjects were enrolled in the study. Of these, 50 subjects (5.2%) experienced NIV intolerance after a median 2.4 h of NIV support. Age (OR ‫؍‬ 0.98, 95% CI 0.963-0.996) and heart rate (OR ‫؍‬ 1.02, 95% CI 1.006 -1.030) measured before NIV were 2 independent risk factors of NIV intolerance. After 1-2 h of NIV, independent risk factors of NIV intolerance were heart rate (OR ‫؍‬ 1.03, 95% CI 1.016 -1.044) and breathing frequency (OR ‫؍‬ 1.06, 95% CI 1.027-1.099). Intolerant subjects had no improvement in mean arterial pressure, heart rate, or breathing frequency after the NIV intervention. Moreover, intolerant subjects had a higher intubation rate (44.0% vs 25.8%, P ‫؍‬ .008) and higher mortality (34.0% vs 22.4%, P ‫؍‬ .08). The three most common complaints were that NIV worsened subjects' distress (46%), that NIV resulted in dyspnea (26%), and that the flow or pressure of NIV was too strong to bear (16%). CONCLUSIONS: NIV intolerance worsened subjects' outcomes. Younger subjects with a high heart rate and breathing frequency may be more likely to experience NIV intolerance.

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“…Utilization of NIV has been increasing worldwide, probably due to increased evidence and experience, as well as published guidelines favoring increased NIV use, especially for diagnoses like COPD and CPE (5)(6)(7)(8)(9)(26)(27)(28)(29). COPD was shown to be the most frequent indication in most of the previous surveys, and NIV utilization rate for ACLD is shown to be mid-70s in real-life studies (7,8,12,(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Approach of pulmonologists in turkey to noninvasive mechanical ventilation use in acute respiratory failure

Ergan²,

H³

et al. 2015

Tuberk Toraks

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Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema

Cited by 90 publications

References 113 publications

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

Approach of pulmonologists in turkey to noninvasive mechanical ventilation use in acute respiratory failure

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