Noninvasive Ventilation in the Cardiac Intensive Care Unit.
Christopher S SchenckFouad ChouairiDavid M DudzinskiP Elliott MillerPublished in: Journal of intensive care medicine (2024)
Over the last several decades, the cardiac intensive care unit (CICU) has seen an increase in the complexity of the patient population and etiologies requiring CICU admission. Currently, respiratory failure is the most common reason for admission to the contemporary CICU. As a result, noninvasive ventilation (NIV), including noninvasive positive-pressure ventilation and high-flow nasal cannula, has been increasingly utilized in the management of patients admitted to the CICU. In this review, we detail the different NIV modalities and summarize the evidence supporting their use in conditions frequently encountered in the CICU. We describe the unique pathophysiologic interactions between positive pressure ventilation and left and/or right ventricular dysfunction. Additionally, we discuss the evidence and strategies for utilization of NIV as a method to reduce extubation failure in patients who required invasive mechanical ventilation. Lastly, we examine unique considerations for managing respiratory failure in certain, high-risk patient populations such as those with right ventricular failure, severe valvular disease, and adult congenital heart disease. Overall, it is critical for clinicians who practice in the CICU to be experts with the application, risks, benefits, and modalities of NIV in cardiac patients with respiratory failure.
Keyphrases
- cardiac surgery
- respiratory failure
- mechanical ventilation
- intensive care unit
- congenital heart disease
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation
- left ventricular
- emergency department
- case report
- healthcare
- primary care
- oxidative stress
- palliative care
- atrial fibrillation
- early onset
- human health
- climate change
- young adults
- genetic diversity