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1. Alviar CL, Miller P E, McAreavey D, et al. 2018. Positive Pressure Ventilation in Cardiac Intensive Care Unit. JACC ;72 (13):1532-15532. Anjarwani S. 2020. Ventilasi Mekanik Non-Invasif : Mode dan Indikasi dalam Workshop Guidebook Ventilation Management in ICCU. PERKI. Jakarta3. Ponikowski P, Voors AA, Anker SD, et al. 2016. ESC Guidelines fot The Diagnosis and Treatment of Acute and Chronic Heart Failure. European Heart Journal; 37(27):2129-22004. Tubaro M, Vranckx P, Price S, et al. 2015. The ESC Textbook of Intensive and Acute Cardiovascular Care (Second Edition). Oxford University Press. United Kingdom5. Weng CL, Zhao YT, Liu QH, et al. 2010. Meta-alaysis : Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema. Ann Intern Med; 152:590-600

Background

A 55-year-old man came with complaints of severe shortness of breath.The patient has a history of heart disease but not routinely controlled.Physical examination found BP 125/69, HR 140x/min, RR 32x/min,saturation 75%, and obtained fine wet crackles throughout the lungfield. ECG obtained anterior Old Myocardial Infaction (OMI), chest x-rayobtained cardiomegaly with pulmonary edema. Laboratory resultsshowed an increase in BNP (6634 pg/ml), BGA results obtainedhypoxemic respiratory failure with PO2 44.9mmhg and arterial lactate5.8mmol/L. Patients were diagnosed with anterior OMI with ACPE withhypoxemic respiratory failure and then given diuretic, nitrate and NIV(CPAP with PEEP 5cmH2O). Evaluation 3 hours post-therapy showedclinical improvement, PO2 61mmHg, O2 saturation 92% and lactatedecreased by 1.6 mmol/L. NIV therapy was then continued andevaluate BGA revelaed 6 hours is PO2 106 mmhg saturation 98.5%.

Case Illustration

ACPE is one of causes of high respiratory failure. The diagnosis is basedon clinical and diagnostic criteria. NIV is a method used to put positivepressure into the lungs without invasive devices. There are several NIVmodes that can be used the most often is CPAP. In this patient the CPAPmode is chosen where the patient is given constant PEEP which aims toopen alveoli at the end of expiration thereby increasing the surfacearea for oxygen diffusion. In these patients CPAP administrationincreased therapeutic success along with definitive therapy.

Discussion

Rapid and appropriate management is needed in the management ACPE. Giving NIV in these conditions increases the success of therapy, especially in hypoxemic conditions.

Conclusion

1Yudha S, 2Wasyanto T

Patient With Acute Cardiogenic Pulmonary Edema (ACPE) : When Do We Need Non-Invasive Ventilation? :

A Case Report

1Faculty of Medicine, Sebelas Maret University, Surakarta, Central Java, Indonesia

2Departement of Cardiology and Vascular Medicine, Faculty of Medicine Sebelas Maret University/Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia

Acute cardiogenic pulmonary edema,NIV

RCA

Keyword

Reference

Acute cardiogenic pulmonary edema is a high mortality condition that must get fast and appropriate treatment. Theuse of non-invasive ventilation (NIV) can improve respiration and cardiovascular function earlier and can correct thecondition of hypoxemia and respiratory distress quickly.

Figure 1. Electrocardiography

Figure 2. Saturation, PO2 and Laktat Post NIV Therapy

Figure 4. Pressure-Time Curve in BiPAP

Figure 3. Pressure-Time Curve in CPAP

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Before NIV 3 hr 6 hr

Saturation, Po2, and Laktat (Pre and Post NIV)

Saturation PO2 Laktat