Abstract
Noninvasive ventilation (NIV) is a safe and effective technique that can prevent side effects and complications related to endotracheal intubation. Acute cardiogenic pulmonary edema is currently the second most common indication for NIV, mainly in emergency departments. In this article we examine recent literature related to the applications of NIV in the acute setting with regard to patients with acute cardiogenic pulmonary edema. In addition, we examine the epidemiology and the pathophysiology of acute heart failure.
Article PDF
Similar content being viewed by others
References and Recommended Reading
Nieminen MS, Bohm M, Cowie MR, et al.: Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005, 26:384–416.
Badgett RG, Lucey CR, Mulrow CD: Can the clinical examination diagnose left-sided heart failure in adults? JAMA 1997, 277:1712–1719.
Cleland JG, Swedberg K, Follath F, et al.: The EuroHeart Failure Survey programme-a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003, 24:442–463.
Adams KF Jr, Fonarow GC, Emerman CL, et al.: Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005, 149:209–216.
Fonarow GC, Abraham WT, Albert NM, et al.: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design. Am Heart J 2004, 148:43–51.
Ware LB, Matthay MA: Acute pulmonary edema. N Engl J Med 2005, 353:2788–2796.
Aurigemma GP, Gaasch WH: Diastolic heart failure. N Engl J Med 2004, 351:1097–1105.
Wang CS, FitzGerald JM, Schulzer M, et al.: Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 2005, 294:1944–1956.
Shamsham F, Mitchell J: Essentials of the diagnosis of heart failure. Am Fam Physician. 2000, 61:1319–1328.
McCullough PA, Nowak RM, McCord J, et al.: B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from breathing not properly (BNP) multinational study. Circulation. 2002, 106:416–422.
Rodeheffer RJ: Measuring plasma B-type natriuretic peptide in heart failure: good to go in 2004? J Am Coll Cardiol 2004, 44:740–749.
Baggish AL, Siebert U, Lainchbury JG, et al.: A validated clinical and biochemical score for the diagnosis of acute heart failure: the proBNP investigation of dyspnea in the emergency department (PRIDE) acute heart failure score. Am Heart J 2006, 151:48–54.
Dao Q, Krishnaswamy P, Kazanegra R, et al.: Utility of Btype natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 2001, 37:379–385.
Wuerz RC, Meador SA: Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 1992, 21:669–674.
Cotter G, Moshkovitz Y, Milovanov O, et al.: Acute heart failure: a novel approach to its pathogenesis and treatment. Eur J Heart Fail 2002, 4:227–234.
American Heart Association: Heart Disease and Stroke Statistics—2005 Update. Dallas: American Heart Association; 2005:49.
Rudiger A, Harjola VP, Müller A, et al.: Acute heart failure: clinical presentation, one-year mortality, and prognostic factors. Eur J Heart Fail 2005:7:662–670. These data, in aggregate, suggest that despite current treatment, morbidity and mortality of patients hospitalized with AHF remain high.
Fonarow GC, Adams KF Jr, Abraham WT: for the ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in heart failure using classification and regression tree (CART) methodology: analysis of 33,046 patients in the ADHERE registry. JAMA. 2005, 293:572–580.
Gheorghiade M, Zannad F, Sopko G, et al.: Acute heart failure syndromes: current state and framework for future research. Circulation 2005, 112:3958–3968.
Gheorgiade M, De Luca L, Fonarow GC, et al.: Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol 2005, 96(Suppl):11G-17G.
Milo O, Cotter G, Kaluski E, et al.: Comparison of inflammatory and neurohormonal activation in cardiogenic pulmonary edema secondary to ischemic versus nonischemic causes. Am J Cardiol 2003, 92:222–226.
Filippatos G, Leche C, Sunga R, et al.: Expression of FAS adjacent to fibrotic foci the failing human heart is not associated with increased apoptosis. Am J Physiol 1999, 277:H445-H451.
Perna ER, Macin SM, Parras JI, et al.: Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J 2002, 143:814–820.
Aronson D, Mittleman MA, Burger AJ: Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 2004, 116:466–473.
Masip J, Roque M, Sanchez B, et al.: Noninvasive ventilation in acute cardiogenic pulmonary edema systematic review and meta-analysis. JAMA 2005, 294:3124–3130. This is the first meta-analysis that shows a reduction on mortality in patients with CPE treated with non-invasive ventilation.
Rasanen J, Heikkla J, Downs J, et al.: Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol 1985, 55:269–300.
Bersten AD, Holt AW, Vedig AE, et al.: Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991, 325,1825–1830.
Lin M, Yang YF, Chiang HT, et al.: Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema: short-term results and long-term followup. Chest 1995, 107:1379–1386.
Kelly CA, Newby DE, McDonagh TA, et al.: Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary edema. Eur Heart J 2002, 23:1379–1386.
L’Her E, Duquesne F, Girou E, et al.: Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients. Intensive Care Med 2004, 30:882–888.
Mehta S, Jay GD, Woolard RH, et al.: Randomized prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 1997, 25:620–628.
Bellone A, Monari A, Cortellaro F, et al.: Myocardial infarction rate in acute pulmonary edema: noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 2004, 32:1860–1865. In this study, for the first time, the primary end-point was the relationship between NPSV/CPAP and myocardial infarction and the two used modalities were equally effective and safe.
Masip J, Betbese AJ, Paez J, et al.: Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary edema: a randomised trial. Lancet 2000, 356:2126–2132.
Nava S, Carbone G, Dibattista N, et al.: Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter, randomized trial. Am J Respir Crit Care Med 2003, 168:1432–1437. This study provided a strong evidence about the efficacy and safety of NIV in CPE.
Crane SD, Elliot MW, Gilligan P, et al.: Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary edema. Emerg Med J 2004, 21:155–161.
Park M, Sangean M, Volpe M, et al.: Randomized, prospective trial of oxygen continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med 2004, 32:2407–2415. The premature interruption of this study because of a significant difference in ETI rate shows that CPAP and bilevel PAP are the optimal treatment for patients with CPE in comparison with conventional therapy.
Bellone A, Vettorello M, Monari A, et al.: Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema. Intensive Care Med 2005, 31:807–811.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bellone, A., Barbieri, A., Bursi, F. et al. Management of acute pulmonary edema in the emergency department. Curr Heart Fail Rep 3, 129–135 (2006). https://doi.org/10.1007/s11897-006-0012-z
Issue Date:
DOI: https://doi.org/10.1007/s11897-006-0012-z