title: Bi-level positive airway pressure support system use in acute congestive heart failure: preliminary case series.
abstract: OBJECTIVE
  To describe the use of a noninvasive bi-level positive airway pressure (PAP) support system for ED patients with acute congestive heart failure (CHF).
  
  
  METHODS
  Retrospective case series analysis of ED patients presenting with acute CHF in imminent need of endotracheal intubation (ETI) managed with a bi-level PAP system. The bi-level PAP system was applied at the discretion of the treating emergency physician. Management of the bi-level PAP system, including setting of inspiratory PAP (IPAP) and expiratory PAP (EPAP), weaning, adjunct pharmacologic therapy, and failure of bi-level PAP support, was determined by the treating physician.
  
  
  RESULTS
  Only two (9%) of 22 patient presentations necessitated ETI. The mean duration of bi-level PAP therapy was 7.9 hours. The mean maximum IPAP and EPAP settings were 10.8 and 5.8 cm H2O, respectively. Mean intensive care unit length of stay (LOS) was 2.4 days, with a median LOS of only 1 day. There were three deaths in the series; none were attributed to the bi-level PAP system. No technical difficulty with the bi-level PAP system was noted.
  
  
  CONCLUSIONS
  Noninvasive pressure support ventilation with a bi-level PAP support system may avert ETI in acute CHF patients. This device can be effectively used by ED personnel.
authors.affiliation: Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Sacchetti
authors.forename: R H
authors.initials: RH
authors.lastname: Harris
authors.forename: C
authors.initials: C
authors.lastname: Paston
authors.forename: Z
authors.initials: Z
authors.lastname: Hernandez
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors