Rev Cardiovasc Med
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Over the past decade, there have been a number of studies of the use of noninvasive ventilation (NIV) in patients with respiratory failure, including that associated with acute congestive heart failure (CHF). Many of these studies have focused on using NIV in an effort to avoid endotracheal intubation, with its associated complications and costs. Most studies have been small, retrospective, and not well focused on the CHF population. ⋯ Though BLPAP has theoretical advantages over CPAP, there are questions regarding its safety in a setting of CHF. The key to success in using NIV to treat severe CHF is proper patient selection, close patient monitoring, proper application of the technology, and objective therapeutic goals. When used appropriately, NIV can be a useful adjunct in the treatment of a subset of patients with acute CHF at risk for endotracheal intubation.
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For the acutely ill patient presenting to the emergency department with dyspnea, an incorrect diagnosis could place the patient at risk for both morbidity and mortality. The stimulus for B-type natriuretic peptide (BNP) release is a change in left-ventricular wall stretch and volume overload. A rapid, whole-blood BNP assay (Triage BNP Test, Biosite Inc, San Diego, CA) that allows quick evaluation of the dyspneic patient has recently been approved by the U. ⋯ Algorithms are being developed for use in the emergency department that take into account other illnesses that might raise BNP levels. BNP levels should be extremely important in ruling out and diagnosing decompensated CHF, as long as baseline "euvolemic" BNP values are known. Finally, in addition to helping assess whether a dyspneic patient has heart failure, BNP levels may also be useful in making both triage and management decisions.