Non-Invasive Ventilation in Pulmonary Edema

Inclusion Criteria:

• rapid onset of the symptoms

• severe dyspnoea at rest

• respiratory rate > 30 breaths per minute

• use of accessory respiratory muscles

• oxygen saturation (SpO2) inferior to 90% with an inspiratory oxygen fraction of 60%via a Venturi mask

• radiological findings of ACPE

Exclusion Criteria:

• acute ischemic heart disease (myocardial infarction, chest pain, ST elevation)

• hemodynamic instability (i.e. systolic blood pressure < 90 with dopamine or dobutamineinfusion ≥ 5 mcgr/Kg/min) or life-threatening arrhythmias

• need for immediate endotracheal intubation (respiratory arrest, bradypnea or gasping)

• inability to protect the airways

• impaired sensorium (i.e. unconsciousness or agitation)

• inability to clear secretions

• respiratory tract infection

• recent oesophageal/gastric surgery

• gastrointestinal bleeding

• facial deformities

• hematological malignancy or cancer with an Eastern Cooperative Oncology Groupperformance status ≥ 2

• chronic respiratory failure necessitating long-term oxygen therapy

• diagnosis of myocardial infarction, pulmonary embolism, pneumonia, exacerbation ofchronic obstructive pulmonary disease, pneumothorax in the previous 3 months

• denial or refusal of intubation

• claustrophobia

• inclusion in other research protocols