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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number61
JournalBMC Emergency Medicine
Volume18
Issue number1
DOIs
Publication statusPublished - Dec 29 2018

Keywords

  • Emergency department
  • Heart failure
  • Non-invasive ventilation
  • Respiratory

ASJC Scopus subject areas

  • Emergency Medicine

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