What is the role of noninvasive pressure-support ventilation (NPSV) in the treatment of cardiogenic pulmonary edema (CPE)?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Consider noninvasive pressure-support ventilation (NPSV) early when treating patients with severe CPE.

In NPSV, the patient breathes through a face mask against a continuous flow of positive airway pressure. NPSV maintains the patency of the fluid-filled alveoli and prevents them from collapsing during exhalation. As a result, the patient saves energy that would have been spent trying to reopen collapsed alveoli. NPSV improves pulmonary air exchange, and it increases intrathoracic pressure with reduction in preload and afterload.

Several studies suggest that NPSV is associated with decreased length of stay in the ICU, decreased need for mechanical ventilation, and decreased hospital costs. A few clinical trials showed that in patients with CPE—mainly defined as having severe dyspnea, oxygen saturation of less than 90%, and basal rales—early and prehospital NPSV treatment by paramedics is safe and associated with faster improvement of oxygen saturation. [14, 15] However, the mortality and the need for intensive care did not differ between the patients who were treated with NPSV and those who were treated with a Venturi face mask in most of those studies. Indeed, a more recent study that evaluated the safety and efficacy of implementing prehospital CPAP for the treatment of acute (CPE) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) found no benefit in morbidity, mortality, and length of hospital stay. [16]


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