Treatment of acute heart failure(respiratory care) Takuya KAWAGUCHI 1 , Yuki KISHIHARA 1 , Hideto YASUDA 2 1Department of Emergency Medicine Japanese Red Cross Musashino Hospital 2Department of Emergency Medicine Jichi Medical University Saitama Medical Center pp.3-16
Published Date 2021/1/1
DOI https://doi.org/10.11477/mf.3102200828
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Acute heart failure is caused by three mechanisms:acute cardiogenic pulmonary edema (ACPE), systemic fluid retention, and low cardiac output. Noninvasive positive pressure ventilation (NPPV) is frequently used for treatment because of the effects of positive end expiratory pressure (PEEP) and cardiorespiratory interaction. For patients with ACPE, alveolar release by PEEP improves shunting and pulmonary compliance which may lead to resolution of the condition. For patients with low cardiac output cardiorespiratory interaction is divided into three mechanisms:decreasing ventricular preload by positive intrathoracic pressure, decreasing ventricular afterload by decreasing transmural pressure in the systolic phase and decreasing pulmonary vascular resistance by improving hypoxia. These mechanisms may be invoked to improve cardiac output. A number of clinical studies of NPPV have been conducted and high level evidence has been reported regarding the benefits of NPPV in patients with ACPE. Various guidelines also state that NPPV should be used as the first choice based on a high level of evidence. There are other choices instead of NPPV such as high-flow nasal cannula and mechanical ventilation in patients with ACPE, but there is not enough evidence accumulated yet to consider recommendations. The key to successful management of NPPV is to dispel the notion that “just wearing a mask” in addition to thinking properly about the adaptation. Although the level of evidence is not yet high, it is imperative to use appropriate methods for the implementation, setting, monitoring, and withdrawal of NPPV.

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