Noninvasive ventilation in acute cardiogenic pulmonary edema.

PURPOSE OF REVIEW

Patients with acute pulmonary edema are often treated with noninvasive ventilation (NIV). There are essentially two modalities used in this setting: continuous positive airway pressure and bilevel pressure support ventilation. The clinical impact of these techniques and the subset of patients who can benefit from their application have not been definitely established.

RECENT FINDINGS

The main advantage of the use of NIV in patients with severe acute pulmonary edema is to avoid intubation by more effectively decreasing respiratory distress with respect to conventional oxygen therapy. These beneficial effects were demonstrated in three meta-analyses including nearly 900 patients. Although neither technique was superior to the other in the comparative analysis, a tendency to reduce hospital mortality was observed, which was statistically significant for continuous positive airway pressure. However, unpublished data from a large multicenter trial comparing both modalities of NIV to conventional treatment in emergency departments did not confirm these results. Recent research has pointed out a clear advantage when the treatment is initiated early in the prehospital setting.

SUMMARY

Although in acute pulmonary edema NIV is more effective in improving respiratory distress than conventional oxygen therapy and reduces the necessity of intubation, the subset of patients who can best benefit from these techniques in terms of mortality still warrant further investigation.