Prehospital care of patients with acute cardiogenic pulmonary edema: The importance of using non-invasive lung ventilation

Introduction: Cardiogenic pulmonary edema is an extravascular accumulation of fluid in the pulmonary interstitium and/or alveolar space. Drugs used in the treatment of acute cardiogenic pulmonary edema at the prehospital level include nitrates, diuretics, morphine and inotropes. If the patient has respiratory distress, acidosis, or hypoxia, despite supplemental oxygen, noninvasive ventilation is indicated. Objective: An overview of the fastest and most efficient way to stabilize patients who are in respiratory failure due to acute cardiogenic pulmonary edema and are 40 km away from the nearest inpatient health facility. Material and methods: The paper is a retrospective study conducted by analyzing data from electronic records of the Šid Emergency Medical Service. Results: The study included 19 patients aged 58 to 89 years. Initial saturation ranged from 55-90%, while the final one was 90-97%. In 11 cases BiPAP ventilation was used, in 5 cases CPAP mode, while 3 patients were on oxygen support only. Discussion: In most cases BiPAP mode was used, which has been shown to be superior to CPAP mode in practice. Patients on BiPAP mode had an increase in saturation of 6-41%, with the former having an initial 88%, while all other patients improved by more than 20%, while patients on CPAP mode had an improvement of 8-24%. Conclusion: The use of non-invasive mechanical ventilation is absolutely indicated as a treatment measure in the initial management of acute pulmonary edema at the prehospital level, in order to improve gas exchange in respiratoryly compromised patients. Based on the results of the study, it can be concluded that BiPAP mode takes precedence over CPAP, and the most important parameter that indicates this fact at the prehospital level is oxygen saturation, actually the percentage of hemoglobin in the blood that is saturated with oxygen.