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Acute Pulmonary Oedema - NIV — EECC MCQ

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EasyHeart FailureAcute Pulmonary Oedema - NIVEECC

A 68-year-old woman is admitted with acute pulmonary oedema (respiratory rate 35, SpO2 82% on air, BP 160/95 mmHg). She is alert and sitting upright. CXR confirms bilateral pulmonary oedema. What is the most appropriate initial respiratory support?

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Correct answer: C — Non-invasive ventilation (CPAP or BiPAP) with concurrent intravenous furosemide and GTN infusion

Acute cardiogenic pulmonary oedema with severe respiratory distress (RR >25, SpO2 <90%) in an alert patient should be managed with non-invasive ventilation (NIV), either CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure). The 3CPO trial and meta-analyses show that NIV reduces intubation rates and improves dyspnoea more rapidly than standard oxygen therapy. Concurrent treatment includes IV furosemide (40-80 mg) and IV GTN infusion (particularly when BP is preserved or elevated as in this case). Intubation should be reserved for patients with respiratory failure despite NIV, reduced consciousness, or haemodynamic instability.

Reference: ESC (2023): Focused Update on Heart Failure; NICE AHF Guidelines