Indications and practical approach to non-invasive ventilation in acute heart failure

In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to...

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Published in:	European heart journal Vol. 39; no. 1; p. 17
Main Authors:	Masip, Josep, Peacock, W Frank, Price, Susanna, Cullen, Louise, Martin-Sanchez, F Javier, Seferovic, Petar, Maisel, Alan S, Miro, Oscar, Filippatos, Gerasimos, Vrints, Christiaan, Christ, Michael, Cowie, Martin, Platz, Elke, McMurray, John, DiSomma, Salvatore, Zeymer, Uwe, Bueno, Hector, Gale, Chris P, Lettino, Maddalena, Tavares, Mucio, Ruschitzka, Frank, Mebazaa, Alexandre, Harjola, Veli-Pekka, Mueller, Christian
Format:	Journal Article
Language:	English
Published:	England 01.01.2018
Subjects:	Acute Disease Heart Failure - physiopathology Heart Failure - therapy Humans Noninvasive Ventilation CPAP Bilevel pressure support High-flow nasal cannula Non-invasive ventilation Acute cardiogenic pulmonary oedema Acute heart failure
ISSN:	1522-9645, 1522-9645
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Abstract	In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.
AbstractList	In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique. In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.
Author	Masip, Josep Cullen, Louise Miro, Oscar Peacock, W Frank Martin-Sanchez, F Javier Ruschitzka, Frank Mueller, Christian DiSomma, Salvatore Filippatos, Gerasimos Seferovic, Petar Christ, Michael Vrints, Christiaan Zeymer, Uwe Lettino, Maddalena Price, Susanna Tavares, Mucio Gale, Chris P Maisel, Alan S McMurray, John Cowie, Martin Platz, Elke Bueno, Hector Mebazaa, Alexandre Harjola, Veli-Pekka
Author_xml	– sequence: 1 givenname: Josep surname: Masip fullname: Masip, Josep organization: Department of Cardiology, Hospital Sanitas CIMA, Barcelona, Manuel Girona 33, ES 08034 Barcelona, Spain – sequence: 2 givenname: W Frank surname: Peacock fullname: Peacock, W Frank organization: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA – sequence: 3 givenname: Susanna surname: Price fullname: Price, Susanna organization: Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK – sequence: 4 givenname: Louise surname: Cullen fullname: Cullen, Louise organization: Department of Emergency Medicine, Royal Brisbane and Women's Hospital. Faculty of Health, Queensland University of Technology and University of Queensland, Brisbane, Australia – sequence: 5 givenname: F Javier surname: Martin-Sanchez fullname: Martin-Sanchez, F Javier organization: Department of Emergency, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain – sequence: 6 givenname: Petar surname: Seferovic fullname: Seferovic, Petar organization: Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia – sequence: 7 givenname: Alan S surname: Maisel fullname: Maisel, Alan S organization: Coronary Care Unit and Heart Failure Program, Department of Cardiology, VA San Diego, USA – sequence: 8 givenname: Oscar surname: Miro fullname: Miro, Oscar organization: Department of Emergency, Hospital Clínic, "Processes and Pathologies, Emergencies Research Group" IDIBAPS, University of Barcelona, Catalonia, Spain – sequence: 9 givenname: Gerasimos surname: Filippatos fullname: Filippatos, Gerasimos organization: Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece – sequence: 10 givenname: Christiaan surname: Vrints fullname: Vrints, Christiaan organization: Faculty of Medicine and Health Sciences at University of Antwerp, Antwerp, Belgium – sequence: 11 givenname: Michael surname: Christ fullname: Christ, Michael organization: Department of Emergency Medicine, Luzerner Katonsspital, Lucerne, Switzerland – sequence: 12 givenname: Martin surname: Cowie fullname: Cowie, Martin organization: Department of Cardiology, Imperial College London (Royal Brompton Hospital & Harefield Foundation Trust), London, UK – sequence: 13 givenname: Elke surname: Platz fullname: Platz, Elke organization: Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA – sequence: 14 givenname: John surname: McMurray fullname: McMurray, John organization: British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK – sequence: 15 givenname: Salvatore surname: DiSomma fullname: DiSomma, Salvatore organization: Department of Emergency, Sant'Andrea Hospital. II Faculty of Medicine and Psychology, "LaSapienza", Rome University, Rome, Italy – sequence: 16 givenname: Uwe surname: Zeymer fullname: Zeymer, Uwe organization: Institut für Herzinfarktforschung Ludwigshafen, Klinikum Ludwigshafen, Germany – sequence: 17 givenname: Hector surname: Bueno fullname: Bueno, Hector organization: Centro Nacional de Investigaciones Cardiovasculares, Department of Cardiology, Hospital 12 de Octubre, Madrid, Universidad Complutense de Madrid, Madrid, Spain – sequence: 18 givenname: Chris P surname: Gale fullname: Gale, Chris P organization: Department of Cardiology, York Teaching Hospital, Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, York, UK – sequence: 19 givenname: Maddalena surname: Lettino fullname: Lettino, Maddalena organization: Clinical Cardiology Unit, Humanitas Research Hospital, Italy – sequence: 20 givenname: Mucio surname: Tavares fullname: Tavares, Mucio organization: Department of Emergency, Heart Institute (InCor), University of São Paulo Medical School, Brazil – sequence: 21 givenname: Frank surname: Ruschitzka fullname: Ruschitzka, Frank organization: Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland – sequence: 22 givenname: Alexandre surname: Mebazaa fullname: Mebazaa, Alexandre organization: Department of Anesthesiology and Critical Care, U942 Inserm, APHP Hôpitaux Universitaires Saint Louis Lariboisiére, Université Paris Diderot and Hospital Lariboisiére, Paris, France – sequence: 23 givenname: Veli-Pekka surname: Harjola fullname: Harjola, Veli-Pekka organization: Department of Emergency Medicine and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland – sequence: 24 givenname: Christian surname: Mueller fullname: Mueller, Christian organization: Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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Copyright	Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.
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