Non invasive mechanical ventilation in acute cardiogenic pulmonary edema: is it all done?.

The aim of the paper is to critically analyse the results obtained by recent literature concerning the most important aspects of application of Non Invasive Mechanical Ventilation for the treatment of Acute Cardiogenic Pulmonary Edema, and to elaborate a definition of what is, on the whole, widely accepted, focusing the attention on those issues which still remain unanswered and therefore require further studies. MEDLINE was searched and the bibliography of a selected group of articles was perused. The literature was analysed and the information gathered has proved to address the questions in a systematic way. All studies concerning the use of a non invasive ventilation technique in the treatment of acute pulmonary edema or acute respiratory failure which included pulmonary edema have been considered. New physiological issues have been introduced on the pathogenesis of acute pulmonary edema. Even though very little non invasive ventilation has been performed outside intensive care units, a growing interest is rising in the opportunity of transferring this technique to a different setting which would include critically ill patients. No random controlled trials and studies have ever established whether positive pressure support is really better than continuous airway pressure, but several trials appear to have excluded the potential for high-risk in the use of assisted ventilation. General opinion has not yet confirmed foreseeable failures in non invasive ventilation at the time of patient admission. A good deal of favorable experimental evidence supports the use of non invasive ventilation in the acute pulmonary edema and guarantees safety when used in intensive care units. Very few trials have been carried out in order to explore application on severe pulmonary edema outside intensive care unit. A whole new world of old and new issues on patient selection criteria, ventilation times, type of ventilation and predictability of failure, could be discovered.