Management of Acute Cardiogenic Pulmonary Oedema

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Afterload: Negative PressurePulmonary Oedema• Markedly negative swings in ITP fromspontaneous ventilation increasesafterload and may precipitate ACPOparticularly with LV dysfunction• This can also occur in well compensatedpatients. Young fit malesStalcup: NEJM 1977Sofer: Chest 1984Beach: CCM 1973
Therapy: NIV with PEEP• Consider as early as possible with ACPO• Improves clinical parameters and LVfunction by reducing LV afterload• 3 meta-analyses showed reduced intubationand short-term mortalityMasip Heart Fail Rev 2007 &JAMA 2005Peter Lancet 2006
Page 1 and 2: Management of AcuteCardiogenic Pulm
Page 3 and 4: Prognosis• 50% are dead at 4 yrs
Page 5 and 6: Diastolic HF: HFPEF• Symptoms ±
Page 7 and 8: Diagnosis of Heart FailureDickstein
Page 9 and 10: ACPO is Frequently not Associatedwi
Page 11 and 12: Pulmonary CongestionRARVLUNGINCREAS
Page 13 and 14: Isolated right HF:• Low output sy
Page 15 and 16: Classification of HF severity inMI:
Page 17 and 18: Tako-tsubo• “Stress-induced CMO
Page 19 and 20: Tako-tsubo: Mechanisms• Myocardia
Page 21 and 22: Tako-tsubo: Systole: No contraction
Page 23 and 24: ACPO: Conditions where diureticsmay
Page 25 and 26: NIV: Haemodynamic Response• RV pr
Page 27 and 28: LV AfterloadDetermined by:• Ventr
Page 29: LV Afterload: Transmural TensionIPP
Page 33 and 34: CPAP vs. Conventional therapy• 5
Page 35 and 36: CPAP: Practicalities• 5- 7.5cmH 2
Page 37 and 38: Fluid Status: SVV/PPVMeta-analysis
Page 39 and 40: Thermodilution Decay CurveITTV = CO
Page 41 and 42: Fluid Status: GEDV/ITBV• Lower va
Page 43 and 44: “Normal Values”• CI 3.0 - 5.0
Page 45: Case Study CVP 8Male 56: Post extub

Management of Acute Cardiogenic Pulmonary Oedema

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