Citation Information :
Sivadas M. Noninvasive ventilation in patients with acute cardiogenic pulmonary oedema: A prospective study to quantify adequate PEEP. Indian J Respir Care 2012; 1 (1):37-41.
Introduction: Patients with heart failure developing acute pulmonary oedema benefit from immediate administration of noninvasive respiratory support such as continuous positive airway pressure (CPAP) or Biphasic positive airway pressure (BIPAP). Objective: To quantify the most advantageous positive end-expiratory pressure (PEEP) required to improve patient's oxygenation and to evaluate outcome of noninvasive respiratory support in patients with cardiogenic pulmonary oedema. Methods: This was a nonrandomised interventional study. Patients admitted with acute cardiogenic pulmonary oedema to the cardiac intensive care unit were initiated on CPAP/ BIPAP mode of ventilation noninvasively. They were evaluated for the most advantageous PEEP that improved their symptoms. Results: A total of thirty two patients were studied. Twenty four patients were included in the CPAP group [mean (± SD) age of (63.66 ± 11.18) years)] and eight in BIPAP group [mean (± SD) age of (67.25 ± 12.6) years]. Most advantageous PEEP (mean (± SD) in CPAP group was 5.62 ± 1.24 cm H2O and in BIPAP group was 7.125 ± 1.8 cm H2O (P = 0.0125). Lower serum bicarbonate levels were found at baseline in the BIPAP group (14.4 ± 6.3 mmol/L) compared to CPAP group (19.4 ± 5.59 mmol/L, P < 0.041). Patients in BIPAP group needed a longer hospital stay (19.62 ± 14.9 days) compared to CPAP group of 8.12 ± 6.58 days (P 0.0047). Conclusions: Most patients of cardiogenic pulmonary oedema can be managed noninvasively with CPAP but patients with metabolic acidosis are likely to require BIPAP and a longer duration of hospital stay.
Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991; 325:1825–30.
Anthonisen NR, Smith HJ. Respiratory acidosis as a consequence of pulmonary edema. Ann Intern Med 1965; 62:991–9.
Pingleton SK. Complications of acute respiratory failure. Am Rev Respir Dis 1988;137:1463–93.
Park M, Sangean MC, Volpe Mde S, Feltrim MI, Nozawa E, Leite PF, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary oedema. Crit Care Med 2004; 32:2407–15.
Katz J, Kraemer R, Gjerde G. Inspiratory work and airway pressure with continuous positive airway pressure delivery systems. Chest 1985; 88:519–26.
Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of noninvasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet 2006; 367:1155–63.
Pang D, Keenan SP, Cook DJ, Sibbald WJ. The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: A systematic review. Chest 1998; 114:1185– 92.
Seals DR, Suwarno NO, Dempsey JA. Influence of lung volume on sympathetic nerve discharge in normal humans. Circ Res 1990; 67: 130–41.
Sinuff T, Cook DJ, Randall J, Allen CJ. Evaluation of a practice guideline for noninvasive positive-pressure ventilation for acute respiratory failure. Chest 2003; 123:2062–73.
Masip J, Betbesé AJ, Páez J, Vecilla F, Cañizares R, Padró J, et al: Noninvasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 2000; 356: 2126–32.
Mehta S, Jay GD, Woolard RH, Hipona RA, Connolly EM, Cimini DM, et al. Randomised, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary oedema. Crit Care Med 1997; 25:620–8.
Park M, Sangean MC, Volpe Mde S, Feltrim MI, Nozawa E, Leite PF, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary oedema. Crit Care Med 2004; 32:2407–15.
Bellone A, Monari A, Cortellaro F, Vettorello M, Arlati S, Coen D. Myocardial infarction rate in acute pulmonary oedema: Noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 2004; 32:1860–5.
Winck JC, Azevedo LF, Costa-Pereira A, Antonelli M, Wyatt JC. Efficacy and safety of noninvasive ventilation in the treatment of acute cardiogenic pulmonary oedema – a systematic review and metaanalysis. Crit Care 2006, 10:R69.