The Present and Future
Council Perspectives
Positive Pressure Ventilation in the Cardiac Intensive Care Unit

https://doi.org/10.1016/j.jacc.2018.06.074Get rights and content
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Abstract

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.

Key Words

coronary intensive care unit
heart failure
mechanical ventilation
noninvasive ventilation
pulmonary edema
respiratory failure

Abbreviations and Acronyms

CICU
cardiac intensive care unit
IM-PPV
invasive mechanical positive pressure ventilation
LV
left ventricle
NI-PPV
noninvasive positive pressure ventilation
PEEP
positive end-expiratory pressure
Ppleural
pleural pressure
PPV
positive pressure ventilation
PVR
pulmonary vascular resistance
RV
right ventricle

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The views expressed in this paper by the American College of Cardiology’s (ACC’s) Critical Care Cardiology Working Group does not necessarily reflect the views of the Journal of the American College of Cardiology or the ACC.

This work was supported in part by the National Institutes of Health Clinical Center. Dr. Soble is a cofounder of Ascend, a health care IT company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

Drs. Alviar and Miller contributed equally to this work.

Drs. Solomon and Morrow contributed equally to this work.