Coronary care units are the place, where acute myocardial infarction patients are housed. Thrombolysis is still the primary modality of treatment world over .Large infarcts, , impending or established cardiogenic shock are major source for mortality .
Acute left ventricular failure (LVF ) in CCU has to be swiftly managed in whatever phase of MI .Standard regimen of sedation, diuretics, Nitro glycerine, and Dobutamine are administered are often not good enough .( Its true many of these patients are to be taken for emergency PCI ) Still, medical management of LVF has a huge impact on the outcome.
While cath lab procedures are given top priority , I have seen many times, simple concepts in CCU not getting proper attention.Continuous positive airway pressure(CPAPA/Bilevel-NPPV) aided oxygen administration has a critical role to play in this setting.
- It reduces the work of breathing
- Opens up wasted Vp/Vq zones in lungs
- Interstitial gas diffusion is facilitated by keeping the respiratory units
- Keeps a check on the LVEDP from going to very high levels in an indirect fashion (Lung helping heart !)
Why not Intubate these patients ?
It’s true Intubation and ventilation may be required ultimately in many of these patients. .It has its own issues of prolonging the stay and infection .
Even though the clinical trials do not show consistent impact on long term survival , we have time and again found this modality useful .Timely administration of of CPAP definitely halts the progression of mild forms of LVF to full fledged cardiogenic shock and leads to recovery in many .
CPAP/Bilevel-NPPV is important hemodynamic stabilising tool , that should be used liberally whenever possible .
There has been number of studies exploring the role of CPAP in acute LVF during STEMI.