Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 72, Issue 13, Pages 1532-1553Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.06.074
Keywords
coronary intensive care unit; heart failure; mechanical ventilation; noninvasive ventilation; pulmonary edema; respiratory failure
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Funding
- Heart Failure and Cardiac Transplant Council
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Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival. Invasive PPV can be lifesaving, but has both favorable and unfavorable interactions with left and right ventricular physiology and carries a risk of complications that influence CICU mortality. Effective implementation of PPV requires an understanding of the underlying cardiac and pulmonary pathophysiology. Cardiologists who practice in the CICU should be proficient with the indications, appropriate selection, potential cardiopulmonary interactions, and complications of PPV. (C) 2018 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
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