BMC Emergency Medicine (Dec 2018)

A real life evaluation of non invasive ventilation in acute cardiogenic pulmonary edema: a multicenter, perspective, observational study for the ACPE SIMEU study group

  • Stefano Aliberti,
  • Valentina Diana Rosti,
  • Chiara Travierso,
  • Anna Maria Brambilla,
  • Federico Piffer,
  • Giuseppina Petrelli,
  • Chiara Minelli,
  • Daniele Camisa,
  • Antonio Voza,
  • Giovanna Guiotto,
  • Roberto Cosentini,
  • on behalf of the SIMEU ACPE study group

DOI
https://doi.org/10.1186/s12873-018-0216-z
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 5

Abstract

Read online

Abstract Background During the past three decades conflicting evidences have been published on the use of non-invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). The aim of this study is to describe the management of acute respiratory failure (ARF) due to ACPE in twelve Italian emergency departments (EDs). We evaluated prevalence, characteristics and outcomes of ACPE patients treated with oxygen therapy, continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (BiPAP) on admission to the EDs. Methods In this multicenter, prospective, observational study, consecutive adult patients with ACPE were enrolled in 12 EDs in Italy from May 2009 to December 2013. Three study groups were identified according to the initial respiratory treatment: patients receiving oxygen therapy, those treated with CPAP and those treated with BiPAP. Treatment failure was evaluated as study outcome. Results We enrolled 1293 patients with acute cardiogenic pulmonary edema. 273 (21%) began with oxygen, 788 (61%) with CPAP and 232 (18%) with BiPAP. One out of four patient who began with oxygen was subsequently switched to NIV and initial treatment with oxygen therapy had an odds ratio for treatment failure of 3.65 (95% CI: 2.55–5.23, p < 0.001). Conclusions: NIV seems to be the first choice for treatment of ARF due to ACPE, showing high clinical effectiveness and representing a rescue option for patients not improving with conventional oxygen therapy.

Keywords