Bello Giuseppe, De Santis Paolo, Antonelli Massimo
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Ann Transl Med. 2018 Sep;6(18):355. doi: 10.21037/atm.2018.04.39.
Cardiogenic pulmonary edema (CPE) is among the most common causes of acute respiratory failure (ARF) in the acute care setting and often requires ventilatory assistance. In patients with ARF due to CPE, use of non-invasive positive airway pressure can decrease the systemic venous return and the left ventricular (LV) afterload, thus reducing LV filling pressure and limiting pulmonary edema. In these patients, either non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) can improve vital signs and physiological parameters, decreasing the need for endotracheal intubation (ETI) and hospital mortality when compared to conventional oxygen therapy. Results on the use of NIV or CPAP in patients with CPE prior to hospitalization are not homogeneous among studies, hampering any conclusive recommendation regarding their role in the pre-hospital setting.
心源性肺水肿（CPE）是急性护理环境中急性呼吸衰竭（ARF）最常见的病因之一，通常需要通气支持。在因CPE导致ARF的患者中，使用无创气道正压通气可减少体循环静脉回流和左心室（LV）后负荷，从而降低LV充盈压并限制肺水肿。在这些患者中，与传统氧疗相比，无创通气（NIV）或持续气道正压通气（CPAP）均可改善生命体征和生理参数，减少气管插管（ETI）需求及医院死亡率。关于住院前使用NIV或CPAP治疗CPE患者的研究结果并不一致，这妨碍了就其在院前环境中的作用给出任何确定性建议。
