Indications and practical approach to non-invasive ventilation in acute heart failure

Josep Masip, W Frank Peacock, Susanna Price, Louise Cullen, F Javier Martin-Sanchez, Petar Seferovic, Alan S Maisel, Oscar Miro, Gerasimos Filippatos, Christiaan Vrints, Michael Christ, Martin Cowie, Elke Platz, John McMurray, Salvatore DiSomma, Uwe Zeymer, Hector Bueno, Chris P Gale, Maddalena Lettino, Mucio TavaresFrank Ruschitzka, Alexandre Mebazaa, Veli-Pekka Harjola, Christian Mueller, Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology

Research output: Contribution to journalArticle

Abstract

In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.

Original languageEnglish
Pages (from-to)17-25
Number of pages9
JournalEuropean Heart Journal
Volume39
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Noninvasive Ventilation
Heart Failure
Continuous Positive Airway Pressure
Respiratory Insufficiency
Cardiogenic Shock
Pulmonary Edema
Mechanical Ventilators
Pressure
Intratracheal Intubation
Positive-Pressure Respiration
Hypercapnia
Patient Selection
Lung Diseases
Ventilation
Hemodynamics
Outcome Assessment (Health Care)
Oxygen
Equipment and Supplies
Mortality
Therapeutics

Keywords

  • Journal Article

Cite this

Masip, J., Peacock, W. F., Price, S., Cullen, L., Martin-Sanchez, F. J., Seferovic, P., ... Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology (2018). Indications and practical approach to non-invasive ventilation in acute heart failure. European Heart Journal, 39(1), 17-25. https://doi.org/10.1093/eurheartj/ehx580

Indications and practical approach to non-invasive ventilation in acute heart failure. / Masip, Josep; Peacock, W Frank; Price, Susanna; Cullen, Louise; Martin-Sanchez, F Javier; Seferovic, Petar; Maisel, Alan S; Miro, Oscar; Filippatos, Gerasimos; Vrints, Christiaan; Christ, Michael; Cowie, Martin; Platz, Elke; McMurray, John; DiSomma, Salvatore; Zeymer, Uwe; Bueno, Hector; Gale, Chris P; Lettino, Maddalena; Tavares, Mucio; Ruschitzka, Frank; Mebazaa, Alexandre; Harjola, Veli-Pekka; Mueller, Christian; Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology.

In: European Heart Journal, Vol. 39, No. 1, 01.01.2018, p. 17-25.

Research output: Contribution to journalArticle

Masip, J, Peacock, WF, Price, S, Cullen, L, Martin-Sanchez, FJ, Seferovic, P, Maisel, AS, Miro, O, Filippatos, G, Vrints, C, Christ, M, Cowie, M, Platz, E, McMurray, J, DiSomma, S, Zeymer, U, Bueno, H, Gale, CP, Lettino, M, Tavares, M, Ruschitzka, F, Mebazaa, A, Harjola, V-P, Mueller, C & Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology 2018, 'Indications and practical approach to non-invasive ventilation in acute heart failure', European Heart Journal, vol. 39, no. 1, pp. 17-25. https://doi.org/10.1093/eurheartj/ehx580
Masip J, Peacock WF, Price S, Cullen L, Martin-Sanchez FJ, Seferovic P et al. Indications and practical approach to non-invasive ventilation in acute heart failure. European Heart Journal. 2018 Jan 1;39(1):17-25. https://doi.org/10.1093/eurheartj/ehx580
Masip, Josep ; Peacock, W Frank ; Price, Susanna ; Cullen, Louise ; Martin-Sanchez, F Javier ; Seferovic, Petar ; Maisel, Alan S ; Miro, Oscar ; Filippatos, Gerasimos ; Vrints, Christiaan ; Christ, Michael ; Cowie, Martin ; Platz, Elke ; McMurray, John ; DiSomma, Salvatore ; Zeymer, Uwe ; Bueno, Hector ; Gale, Chris P ; Lettino, Maddalena ; Tavares, Mucio ; Ruschitzka, Frank ; Mebazaa, Alexandre ; Harjola, Veli-Pekka ; Mueller, Christian ; Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology. / Indications and practical approach to non-invasive ventilation in acute heart failure. In: European Heart Journal. 2018 ; Vol. 39, No. 1. pp. 17-25.
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AU - Masip, Josep

AU - Peacock, W Frank

AU - Price, Susanna

AU - Cullen, Louise

AU - Martin-Sanchez, F Javier

AU - Seferovic, Petar

AU - Maisel, Alan S

AU - Miro, Oscar

AU - Filippatos, Gerasimos

AU - Vrints, Christiaan

AU - Christ, Michael

AU - Cowie, Martin

AU - Platz, Elke

AU - McMurray, John

AU - DiSomma, Salvatore

AU - Zeymer, Uwe

AU - Bueno, Hector

AU - Gale, Chris P

AU - Lettino, Maddalena

AU - Tavares, Mucio

AU - Ruschitzka, Frank

AU - Mebazaa, Alexandre

AU - Harjola, Veli-Pekka

AU - Mueller, Christian

AU - Acute Heart Failure Study Group of the Acute Cardiovascular Care Association and the Committee on Acute Heart Failure of the Heart Failure Association of the European Society of Cardiology

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.

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