Non-invasive ventilation for acute pulmonary oedema

Extract in full from NHS Evidence: Sept 2011

Overview: Pulmonary oedema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. It is frequently caused by disease affecting the heart’s left ventricle and may complicate the presentation of acute heart failure. The condition is a common medical emergency which requires urgent intensive treatment to reduce the risk of mortality.

Current treatment: Treatment of acute pulmonary oedema (ACPO) should be directed at reversing the specific cause, although this is not always possible.

Management is otherwise supportive and directed at improving oxygenation, perfusion and haemodynamics, and preventing further cardiac and/or renal damage.

Emergency treatment of acute heart failure includes morphine, nitrates, oxygen, diuretics and non-invasive ventilation (NIV), with urgent angiography if acute coronary syndrome is thought to be the cause. 
New evidence: A randomised controlled trial, carried out across 26 UK hospitals, set out to measure health utility and survival in patients with acute cardiogenic pulmonary oedema, identify predictors of outcome and determine the effect of initial treatment with NIV on outcomes (Goodacre, S et al. Emerg Med J 2011 28: 477-482).
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