The role of continuous positive airway pressure in acute cardiogenic edema with preserved left ventricular systolic function

Bellone, Andrea; Vettorello, Marco; Etteri, Massimiliano; Bonetti, Chiara; Gini, Giancarlo; Mariani, Massimo A.; Berruti, Vittorio; Clerici, D; Minelli, Chiara Maria Fiorella; Nessi, Italo; Maino, Carlo

doi:10.1016/j.ajem.2008.07.008

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Two-dimensional echocardiograms (MyLab25, Esaote, Genova, Italy) were performed to assess patients qualitatively with atrial (left atrium) chambers and/or significant valvular abnormalities, as previously described 7. The competency of the emergency physician ultrasonographers was certified by a multi-step training programme.…”

Section: Methodsmentioning

confidence: 99%

Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial

Bellone

Etteri²,

Vettorello³

et al. 2011

Emerg Med J

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Section: Methodsmentioning

confidence: 99%

Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial

Bellone

Etteri²,

Vettorello³

et al. 2011

Emerg Med J

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“…Toplam 32 çalışma ve 2916 hastayı kapsayan meta-analizde, NIMV'un, AKPÖ'de standart tedaviye göre hastane mortalitesi ve entübasyon ihtiyacını anlamı olarak azalttığı ve akut miyokardiyal infarktüs insidensini artırmadığı saptanmıştır (12) . (13) . Diyastolik kalp yetmezlikli dokuz hastanın değerlendirildiği bir başka çalışmada, CPAP'ın (10 cmH 2 O) sol ventrikül diyastol sonu volümünü azalttığı, oksijenizasyon ve solunum parametrelerini düzelttiği bulunmuştur (14) .…”

Section: Akut Kardiyojenik Pulmoner öDemunclassified

Acute NIMV

Çiledağ¹,

Kaya²

2018

GGHS

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Pozitif basınçlı ventilasyonun kullanılmaya başlanmasından sonra, bir maske aracılığıyla noninvaziv mekanik ventilasyon (NIMV) kullanımı oldukça artmıştır. NIMV, akut solunum yetmezliğinde çok önemli bir tedavi yöntemi olup, KOAH akut atak gibi bazı hastalıklarda invaziv mekanik ventilasyonu (İMV) önlediği, süresini kısalttığı ve İMV ile ilişkili riskler ve komplikasyonları azalttığı gösterilmiştir. Erken tanı, uygun maske ve ventilatör ayarlarının seçimi, ventilatör grafikleri ve kaçağı da içeren yakın monitörizasyon ve hasta-ventilatör asenkronizasyonunun tedavisi NIMV başarısında çok önemlidir.

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“…Consequently, caution must be used because patients with diastolic heart failure are sensitive to preload reduction and may develop hypotension or prerenal azotemia. 13 Contrastively, two preliminary studies 15,16 have shown that CPAP seems to be safe and effective to treat patients with diastolic ACPE. The benefits of CPAP are probably due to the fact that positive pressure reduces not only venous return but also left ventricular transmural pressure in acute diastolic dysfunction where left ventricular afterload is increased.…”

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confidence: 99%

Noninvasive ventilation in patients with acute cardiogenic pulmonary edema

et al. 2013

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The term noninvasive ventilation (NIV) encompasses two different modes of delivering positive airway pressure, namely continuous positive airway pressure (CPAP) and bilevel positive airway pressure (bilevel-PAP). The two modes are different since CPAP does not actively assist inspiration whereas bilevel-PAP does. Bilevel-PAP is a type of noninvasive ventilation that helps keep the upper airways of the lungs open by providing a flow of air delivered through a face mask. The air is pressurized by a machine, which delivers it to the face mask through long, plastic hosing. With bilevel-PAP, the doctor prescribes specific alternating pressures: a higher pressure is used to breathe in (inspiratory positive airway pressure) and a lower pressure is used to breath out (expiratory positive airway pressure). Noninvasive ventilation has been shown to reduce the rate of tracheal intubation. The main indications are exacerbation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema (ACPE). This last is a common cause of respiratory failure with high incidence and high mortality rate. Clinical findings of ACPE are related to the increased extra-vascular water in the lungs and the resulting reduced lung compliance, increased airway resistance and elevated inspiratory muscle load which generates a depression in pleural pressure. These large pleural pressure swings are responsible for hemodynamic changes by increasing left ventricular afterload, myocardial transmural pressure, and venous return. These alterations can be detrimental to patients with left ventricular systolic dysfunction. Under these circumstances, NIV, either by CPAP or bilevel-PAP, improves vital signs, gas exchange, respiratory mechanics and hemodynamics by reducing left ventricular afterload and preload. In the first randomized study which compared the effectiveness of CPAP plus medical treatment vs medical treatment alone, the CPAP group showed a significant decrease in its 48 h mortality rate and no patient required endotracheal intubation. This result was successively confirmed in many reviews and meta-analyses.There are still unanswered questions regarding the role of NIV in ACPE: this review aims to support clinicians treating patients in emergency departments with various presentations of ACPE. It also covers recent developments in the treatment of ACPE and associated evidence.

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The role of continuous positive airway pressure in acute cardiogenic edema with preserved left ventricular systolic function

Cited by 7 publications

References 27 publications

Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial

Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial

Acute NIMV

Noninvasive ventilation in patients with acute cardiogenic pulmonary edema

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