The use of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema.

The patient with acute heart failure may present with acute cardiogenic pul- monary edema (ACPE), a condition accompa- nied by severe respiratory distress, with crack- les over the lung and orthopnea, and an O2 sat- uration usually < 90% on room air, prior to treatment. Non-invasive ventilation is the delivery of assisted ventilation without the need for endo- tracheal intubation and an invasive artificial airway. Two techniques are used for ventilatory sup- port: continuous positive airway pressure (CPAP) and non-invasive positive-pressure ventilation (NPPV). There is a strong consensus that one of these two techniques should be used before endotracheal intubation and mechanical venti- lation because non-invasive techniques dra- matically reduce the need for mechanical ven- tilation via endotracheal intubation and its complications. The aim of this review is to evaluate and re- sume the evidence for the use of non-invasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema accord- ing recent literature in order to guide physi- cians in using CPAP and NPPV in patients af- fected by ACPE in clinical practice. Recent literature showed that CPAP and NPPV both significantly decrease the need for endotracheal intubation, and CPAP significant- ly decreases mortality when compared to stan- dard medical treatment. These techniques re- sulted safe and there is no evidence of in- creased risk of acute myocardial infarction (AMI) with either of them. Although both CPAP and NPPV present sim- ilar efficacy, CPAP has been shown to be cheaper and easier to implement in clinical practice and it could be considered the pre- ferred intervention in patients with ACPE espe- cially in the Emergency Department setting.