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