Noninvasive ventilation in acute heart failure: use of continuous positive airway pressure in the emergency department

Carratala JM, Masip J

Noninvasive ventilation is one of the ventilatory support systems available for treating

the patient with acute respiratory failure. Orotracheal intubation is not required. The

main modalities are continuous positive airway pressure (CPAP) and bilevel positive

airway pressure (BiPAP). Both alleviate respiratory distress quickly and have proven useful

for treating acute heart failure due to acute pulmonary edema or pulmonary

hypertension. The need for intubation and mortality are reduced. More experience has

accumulated with CPAP, which is easier to manage and is associated with few

complications. BiPAP, which is more complicated and requires more staff training, has

been shown to improve respiratory failure more quickly in patients with heart failure and

to be more effective in patients with hypercapnia or respiratory muscle fatigue. In spite

of these benefits, noninvasive ventilation is little used in hospital emergency

departments, probably because of the lack of staff training and commitment, low

availability of material resources, and the absence of clear protocols, which ought to be

available in all hospitals. This review aims to describe the role that noninvasive

ventilation plays in improving oxygen saturation in the treatment of acute heart failure

due to acute pulmonary edema or pulmonary hypertension and to define an appropriate

protocol for using these modalities.

Carratala JM, Masip J