Strong evidence supports that NIV reduces intubation rate and mortality in patients with pulmonary edema from heart failure.
Patients in acute respiratory failure (ARF) due to congestive heart failure are the second group of patients for which there is strong evidence to support the application of noninvasive ventilation. There are multiple randomized, controlled studies showing that NIV reduces intubation rate as well as showing a reduction in mortality over conventional therapy in these patients. Based on strong evidence, the use of either NIV or CPAP for patients with cardiogenic pulmonary edema is recommended in several guidelines for the treatment of cardiogenic pulmonary edema.
In the European Society of Cardiology guidelines published in 2005, it is stated that “NIPPV (noninvasive positive pressure ventilation) is a method of providing mechanical ventilation to patients without the need for endotracheal intubation. There is a strong consensus that one of these two techniques (CPAP or NIPPV) should be used before endotracheal intubation and mechanical ventilation. Utilization of non-invasive techniques dramatically reduces the need for endotracheal intubation and mechanical ventilation.”¹
And also the Canadian clinical practice guidelines recommend NIV as the first option for patients with cardiogenic pulmonary edema and respiratory failure who need ventilation support. Another aspect apart from the clinical outcome is addressed in a study by Denise Wilfong, MD which highlights the importance of early management of pulmonary edema by pre-hospital caregivers, showing a cost saving of over US $4,000 per pre-hospital application of CPAP.²