Early continuous positive airway pressure in acute cardiogenic pulmonary oedema

Abstract

Acute heart failure (AHF) syndromes are the most frequent cause of urgent consultation in patients with heart disease.1 In nearly 20% of cases the clinical presentation is acute pulmonary oedema.2 Although the diagnostic criteria of this syndrome have not been universally established, it is frequently defined by the sudden onset of severe dyspnoea and the presence of typical signs on physical examination, alveolar oedema on chest radiograph, and signs of acute respiratory failure. The latter is essential for the diagnosis. Consequently, different forms of AHF presenting with acute respiratory failure, such as hypertensive AHF,3 hypertensive pulmonary oedema,4 flash pulmonary oedema,1,5 and pulmonary oedema without hypertension or associated with acute coronary syndromes,1 may also be considered as acute pulmonary oedema. Approximately half of the patients with acute pulmonary oedema show hypercapnia on admission. Together with severe acidosis and systemic arterial hypotension, this constitutes the main risk parameter for failure of medical treatment and the subsequent need for endotracheal intubation and mechanical ventilation.6 Until the early 1990s, the percentage of patients requiring these procedures was ∼10–25%.7–9 However, several studies have since shown a decrease in the intubation rate as a result of the use of non-invasive ventilation (NIV). This technique delivers ventilatory support, generally applied via a face mask, without the need for an invasive … *Corresponding author. Tel: +34 93 5072700; fax: +34 93 4367131. E-mail address : jmasip{at}ub.edu