Overview Definition of NIV and AHF
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1 Overview Definition of NIV and AHF NIV related changes in mortality NIV related patient benefits Clinical summary and cases NIV in AHF in Switzerland, a short questionaire
2 Definition of NIV and AHF AHF= gradual or rapid change in heart failure signs and symptoms resulting in a need for urgent therapy. NIV=Administration of ventilatory support without using an invasive artificial airway. NIV includes CPAP and NPPV Gheorghiade M, Pang PS. Acute heart failure syndromes. J Am Coll Cardiol. 2009;53:
3 Patient instruction NIV-Maske with O2 Offline: Setup ventilator Capnography if hypercarbia Contraindications? Definite NIV use Possible switch of therapy NIV adaptation O 2 Mask/O 2 Start CPAP Start NIV TIME Jochen.ruediger@kssg.ch 3
4 Mechanical Ventilation in acute heart failure 2nd to myocardial infarction 8 years retrospective analysis Inclusion: STEMI and NSTEMI, single center study 1610 Patients, 136 NIV, 157 ETI More STEMI in ETI than NIV Trend to higher Trop in ETI Pesaro AE et al. PLoS One. 2016;11:e
5 Overview Definition of NIV and AHF NIV related changes in mortality NIV related patient benefits Clinical summary and cases NIV in AHF in Switzerland, a short questionaire
6 The 3CPO trial Multicenter UK Study , 1069 Pat. 1:1:1 randomization There may be no differences in survival Gray A et al, N Engl J Med. 2008; 359:
7 Overview Definition of NIV and AHF Introduction and clinical cases NIV related patient benefits NIV related changes in mortality NIV in AHF in Switzerland, a short questionaire
8 NIV in ARF, acute response (1h) Chr. Horvath et al, St. Gallen
9 Overview Definition of NIV and AHF NIV related changes in mortality NIV related patient benefits Clinical summary and cases NIV in AHF in Switzerland, a short questionaire
10 Treatment recommodation Westhoff M, et al. Pneumologie. 2015;69: USE NIV FOR respiratory rate > 20/min (ESC) Collins S et al Early Management of Patients With Acute Heart Failure: J Card Fail. 2015;21:27-43.
11 Clinical Case 80 y o female Normal weight non-smoker Dyspnea, Denial of chest pain Arrival via ambulance Prefers to sit, but may lay back. TIME 0 ph 7.43 ptco2 pco2 5.3 SpO2 94 HCO3 26 ECG: no specific signs of acute myocardial ischemia efast: absence of pneumothorax, kerley B- lines Nitro transdermal 20 mg, furosomide O2 suppl 2 HR 117 RR 30 BP 164/103 VAS 7 Support - NIV was considered
12 Indications and contraindications against NIV in AHF Symptomatic persistant AHF Persistant hypoxia Hypercarbia Tachypnea Severe Dyspnea Comorbidities GCS <10, severe agitated person GI (e.g. vomiting) Pneumothorax Metabolic acidosis / cause for dyspnea Relative CI: hypotension, facial abnormalities,
13 Clinical Case 80 y o female Normal weight non-smoker Dyspnea, Denial of chest pain Arrival via ambulance Prefers to sit, but may lay back. ECG: no specific signs of acute myocardial ischemia TIME ph 7.43 ptco pco2 5.3 SpO HCO efast: absence of pneumothorax, kerley B- lines Nitro transdermal 20 mg, furosomide Trop positive O2 suppl 2 2 lpm 2lpm 2 2 HR RR BP 164/ /75 132/64 94/49 119/55 VAS Support - 8 8/10 5/14 5/ Jochen.ruediger@kssg.ch 13
14 Overview Definition of NIV and AHF Introduction and clinical cases NIV related patient benefits NIV related changes in mortality NIV in AHF in Switzerland, a short questionaire
15 Use of NIV on Swiss Eds Bingisser / Rüdiger Methods: formalized surveymonkey questionair to all educating Swiss EDs (2 Ti, 10 F, 55 G) - use of NIV / CPAP - usefulness - resources involved - Knowledge about current CHOP issues
16 Demographic differences in Switzerland 100% 75% Swiss German Swiss romand 50% 25% 0% Responses: NIV Use
17 Value of NIV in AHF n Totally agree Agree Indifferent Not agreed Cornerstone therapy 27 44% 41% 11% 4% Important treatment option Patients profit from NIV NIV needs considerable amount of resources % agreement 24 54% 46% 4% 0% 26 46% 54% 0% 0% 44 versus 39 % 23 22% 22% 17% 39%
18 Do you know about CHOP 93.9E? (NIV outside ICU reimbursement) In preparatio n; 5 in use; 1 80 % are unaware that the CHOP code created to cover additional expenses of NIV outside of the Intensive Care Units / Intermediate Care Units unaware; 24
19 Summary Non-invasive ventilation in acute heart failure... mostly symptomatic, time matters... is a powerful but demanding tool... Should be considered in short term persistant severe dyspnea, hypoxemia, hypercapnia... appears to be better implemented by Swiss romands
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