acute cardiogenic pulmonary edema pulmonary edema cardiogenic pulmonary edema heart failure
Conditions
Interventions
High flow oxygen will be delivered by a specialized cannula using an AIRVO flow source (Fisher &
Paykel Healthcare Ltd). The initial flow will be set at 35 L/min and can be increased up to 60 L/min as tolerated by the participants. FiO2 will be adjusted to keep SpO2 94-98% and maintain there for
Experimental Device,Active Comparator Device
High-flow nasal cannula,Non-invasive positive pressure ventilation
Sponsors
Siriraj Research and Development Fund
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Adult patients (18 years of age and above) presenting with ACPE diagnosed by the attending ED physician by meeting all of the following criteria - History of acute dyspnea - Bilateral rales on physical examination - At least one of the following signs on the initial chest radiograph: pulmonary venous congestion, cardiomegaly, and interstitial edema 2. Significant respiratory distress in need for non-invasive respiratory support measures by meeting all of the following - Respiratory rate (RR) > 24 breaths/min - Pulse oximetry (SpO2) < 92% when breathing at room air or arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) < 300 or SpO2/FiO2 < 240 - Signs of respiratory distress, e.g., accessory muscle use
Exclusion criteria
Exclusion criteria: 1. Respiratory failure needing immediate endotracheal intubation, defined as RR > 35 breaths/min, SpO2 < 90% despite oxygen supplement at FiO2= 1.0, or abdominal dyssynchrony 2. Patients with cardiac or respiratory arrest 3. Patients with hemodynamic instability, defined as systolic blood pressure < 90 mmHg or mean arterial pressure < 65 mmHg with signs of poor tissue perfusion 4. Patients with altered mental status, defined as a Glasgow Coma Scale (GCS) score < 13 5. Agitated or non-cooperative patients 6. Patients contraindicated to the use of NIPPV and HFNC, i.e. at risk for aspiration, known or suspected pneumothorax 7. Patients with chronic kidney disease stage V or end-stage renal disease 8. Patients with ST-segment elevation myocardial infarction 9. Patients with do-not-intubate order 10. Patients with long-term non-invasive or invasive respiratory support 11. Patients with a tracheostomy tube 12. Pregnant patients
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Intubation rate 72 hours prospectively observation | — |
Secondary
| Measure | Time frame |
|---|---|
| Intolerance rate 72 hours prospectively observation,All-cause mortality 72 hours prospectively observation,Treatment failure rate (composite of intubation, intolerance, and mortality) 72 hours prospectively observation | — |
Countries
Thailand
Contacts
Public ContactOnlak Ruangsomboon
Department of Emergency Medicine, Siriraj Hospital, Mahidol University
Outcome results
None listed