The Science Journal of the American Association for Respiratory Care
Objective: To assess acute cardiogenic pulmonary edema (ACPE) patient response to ventilatory support provided by non-invasive positive pressure ventilation (NPPV).
Methods: During 1998, a convenience sample of adult patients presenting to the emergency department (ED) with ACPE were entered in the study. All patients received routine therapy consisting of oxygen, nitrates and diuretics. Study patients were started on full mask NPPV using a Mallinckrodt Inc. 7200
Results: Eighteen patients with mean age 76.6 ± 14.7 years were entered in the study. Initial mean values on FiO2 100% by non-rebreather mask: SpO2 89 ± 11%, pH 7.17 ± .13, PaO2 74 ± 27 mm Hg, PaCO2 60 ± 19 mm Hg, Borg score 7.9 ± 1.4, and respiratory rate (RR) 38 ± 7. At 60 minutes following initiation of NPPV the mean values showed: SpO2 98 ± 2%, pH 7.28 ± .09 (p= .007), PaO2 187 ± 122 mm Hg, PaCO2 45 ± 16 mm Hg, Borg score 3.8 ± 2.3 (p= .002), and RR 29 ± 9 (p= .004). NPPV duration ranged from 30 minutes to 36 hours (median 3 hours). There were no problems with patient tolerance of NPPV. Sixteen patients (89%) improved allowing cessation of NPPV. Two patients required ETI (both had concomitant severe COPD). There were no complications of NPPV. Conclusion: Ventilatory support without ETI using a full face mask and conventional volume ventilator is an effective treatment for ACPE. Use of NPPV in the emergency department setting is feasible and may help prevent ETI.