Clinical Experience of Noninvasive Positive Pressure Ventilation in Patients with Acute Cardiogenic Pulmonary Oedema Treated in a Community Hospital in Japan

Yano M Sugiyama S

doi:10.4172/2165-7548.1000196

Abstract

Objective: To review our use of non-invasive positive pressure ventilation (NPPV) for acute cardiogenic pulmonary oedema (ACPO) in the routine clinical management, especially in terms of the timing of endotracheal intubation (ETI) and outcome. Methods: We retrospectively reviewed 61 patients diagnosed with ACPO admitted to our emergency room (ER) or intensive care unit (ICU) and who received NPPV. The reasons for ETI were reviewed, and the intervals between the estimated appropriate time for ETI and the actual time of ETI and in-hospital mortality were recorded. Results: The mortality rate of patients receiving NPPV was 8.2% (five out of 61). Forty-eight patients (78.7%) were successfully weaned off NPPV without ETI, and 13 (21.3%) required ETI. Five of the 13 intubated patients died, but there was no significant difference in the duration of NPPV before ETI between those who survived and those who died. The interval between the estimated appropriate time for ETI and the actual time of ETI was significantly shorter in patients who survived than in those who died (1.9 ± 3.8 hours versus 8.6 ± 5.4 hours, p=0.02). The mortality rate was significantly higher in patients with an interval of longer than 1.8 hours between the estimated appropriate time for ETI and the actual time of ETI (66.7% versus 14.3%, p<0.001). Conclusions: In patients with ACPO receiving NPPV, a delay in performing ETI beyond the appropriate time was significantly associated with increased mortality. The duration of NPPV before ETI was not associated with mortality.

Highlights

Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) ventilation, collectively termed non-invasive positive pressure ventilation (NPPV), appear to be effective means of reducing the rates of endotracheal intubation (ETI) and morbidity and mortality when treating patients with acute cardiogenic pulmonary oedema (ACPO) [1,2,3]
Ventilation in Patients with Acute Cardiogenic Pulmonary Oedema Treated in a Community Hospital in Japan
Study population We retrospectively examined the medical records of 86 patients treated for ACPO in the emergency room (ER) or intensive care unit (ICU) of Shinbeppu Hospital, Japan, between January 2009 and June 2012 and who received NPPV

Summary

Introduction

Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) ventilation, collectively termed non-invasive positive pressure ventilation (NPPV), appear to be effective means of reducing the rates of endotracheal intubation (ETI) and morbidity and mortality when treating patients with acute cardiogenic pulmonary oedema (ACPO) [1,2,3]. Some studies have reported high mortality rates in the small group of patients with chronic obstructive pulmonary disease (COPD) who had an initial successful response to NPPV but subsequently required mechanical ventilation because of a second episode of acute respiratory failure (ARF) [6,10,11]. The proportion of patients requiring mechanical ventilation because of a second episode of ARF has remained stable, the absolute number of patients receiving NPPV has increased over time because of the increased availability of the technique [6].

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