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 p atients presenting to the emergency department (ED) in acute respiratory fa ilure who clinically required endotracheal intubation (ETI) were studied. I n addition to routine therapy consisting of oxygen, nitrates, and diuretics , patients were started on full mask NPPV using a Puritan Bennett 7200 vent ilator delivering pressure support 10 cm H2O, PEEP 5 cm H2O, FiO(2) 100%, P ressure support was titrated to achieve tidal volumes of 5 to 7 mL/kg, and PEEP titrated to achieve oxygen saturation (SaO(2)) > 90%. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and ne ed for ETI, Twenty patients mean age 74.7 +/- 14.3 years were entered on th e study. Initial mean values on FiO(2) 100% by nonrebreather mask: pH 7.17 +/-13, paCO(2) 65.5 +/- 19.4 mmHg, paO(2) 73.8 +/- 27.3 mm Hg, SaO(2) 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 (di fference. 11; 95% CI .04-.19), paCO(2) 45 (difference 20.5; 95% CI 8-33), B org 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 hour s, 45 minutes). Eighteen patients (90%) improved allowing cessation of NPPV . Two patients with concomitant severe chronic obstructive pulmonary diseas e (COPD) required ETI, There were no complications of NPPV. NPPV using full face mask and pressure support provided by a conventional volume ventilato r is an effective treatment for CPE and may help prevent ETI, (Am J Emerg M ed 2001;19:179-181. Copyright (C) 2001 by W.B. Saunders Company).