BI-LEVEL POSITIVE AIRWAY PRESSURE SUPPORT SYSTEM USE IN ACUTE CONGESTIVE-HEART-FAILURE - PRELIMINARY CASE SERIES

Objective: To describe the use of a noninvasive bi-level positive airw ay pressure (PAP) support system for ED patients with acute congestive heart failure (CHF). Methods: Retrospective case series analysis of E D patients presenting with acute CHF in imminent need of endotracheal intubation (ETI) managed with a bi-level PAP system. The bi-level PAP system was applied at the discretion of the treating emergency physici an. Management of the bi-level PAP system, including setting of inspir atory PAP (IPAP) and expiratory PAP (EPAP), weaning, adjunct pharmacol ogic therapy, and failure of bi-level PBP support, was determined by t he treating physician. Results: Only two (9%) of 22 patient presentati ons necessitated ETI. The mean duration of bi-level PAP therapy was 7. 9 hours. The mean maximum IPAP and EPAP settings were 10.8 and 5.8 cm H2O, respectively. Mean intensive carl unit length of stay (LOS) was 2 .4 days, with a median LOS of only 1 day. There were three deaths in t he series; none were attributed to the bi-level PAP system. No technic al difficulty with the bi-level PAP system was noted. Conclusion: Noni nvasive pressure support ventilation with a bi-level PBP support syste m may avert ETI in acute CHF patients. This device can be effectively used by ED personnel.