Non-Invasive Respiratory Support for Acute Cardiogenic Pulmonary Edema in the Acute Care Setting

In patients experiencing acute heart failure, acute cardiogenic pulmonary edema (ACPE) can emerge due to a surge in pulmonary capillary hydrostatic pressure. This escalation triggers a fluid build-up beyond the lymphatic interstitial drainage system's ability to eliminate, leading to a swift increase in interstitial and alveolar fluid volumes. Such accumulation subsequently results in intrapulmonary shunting and an advancing state of respiratory failure. Contemporary evidence hints at the potential of non-invasive ventilation (NIV) to cut back on the reintubation rate, along with the reduction of ICU and hospital mortality rates, particularly among patients scheduled for extubation. The aim of this review is to critically analyze the existent body of evidence concerning the application of NIV in managing ACPE. It seeks to explore the practical aspects of utilizing NIV within an emergency department environment, addressing crucial considerations such as patient selection, commencement of treatment, monitoring protocols, problem-solving strategies, and weaning processes. In addition, our review will also explore the data available on high flow nasal cannula, a relatively recent therapeutic intervention, discussing its role and effectiveness in treating respiratory insufficiency associated with ACPE.