Pressure support noninvasive positive pressure ventilation treatment of acute cardiogenic pulmonary edema

We assessed cardiogenic pulmonary edema (CPE) patient response to full mask pressure support noninvasive positive pressure ventilation (NPPV). Adult patients presenting to the emergency department (ED) in acute respiratory failure who clinically required endotracheal intubation (ETI) were studied. In addition to routine therapy consisting of oxygen, nitrates, and diuretics, patients were started on full mask NPPV using a Puritan Bennett 7200 ventilator delivering pressure support 10 cm H2O, PEEP 5 cm H2O, Fi02 100%. Pressure support was titrated to achieve tidal volumes of 5 to 7 mUkg, and PEEP titrated to achieve oxygen saturation (SaO2) > 90%. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for ETI. Twenty patients mean age 74.7 ± 14.3 years were entered on the study. Initial mean values on Fi02 100% by nonrebreather mask: pH 7.17 ± .13, paC02 65.5 ± 19.4 mmHg, pa02 73.8 ± 27.3 mm Hg, Sa02 89.7 ± 10.0%, Borg score 8.1 ± 1.4, and respiratory rate (RR) 38 ± 6.3. At 60 minutes of NPPV, improvement was statistically significant: pH 7.28 (difference.11; 95% CI .04–.19), paC02 45 (difference 20.5; 95% CI 8–33), Borg score 4.1 (difference 4.0; 95% CI 3–5), and RR 28.2 (difference 9.8; 95% CI 5–14). NPPV duration ranged from 30 minutes to 36 hours (median 2 hours, 45 minutes). Eighteen patients (90%) improved allowing cessation of NPPV. Two patients with concomitant severe chronic obstructive pulmonary disease (COPD) required ETI. There were no complications of NPPV. NPPV using full face mask and pressure support provided by a conventional volume ventilator is an effective treatment for CPE and may help prevent ETI.[]