A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure: A case report

doi:10.1016/j.ijcard.2006.07.151

International Journal of Cardiology

Volume 119, Issue 2, 10 July 2007, Pages 268-270

https://doi.org/10.1016/j.ijcard.2006.07.151 Get rights and content

Abstract

Continuous positive airway pressure (CPAP) is standard treatment for patients with acute cardiogenic pulmonary edema. We describe a patient who had 21 episodes of acute cardiogenic pulmonary edema due to very poor patient compliance. This 64-year old man had end-stage congestive heart failure based on systolic left ventricular dysfunction following two myocardial infarctions. In addition to routine medical treatment 15 episodes of pulmonary edema were successfully treated with Boussignac continuous positive airway pressure (BCPAP). The BCPAP system is a simple, disposable, FDA-approved device that delivers positive pressure without a ventilator. This extraordinary case underscores the utility of the BCPAP system to avoid repeated intubation and mechanical ventilation in patients with cardiogenic pulmonary edema.

Section snippets

Case report

A 64-year old man had a cumulative history of twenty-one coronary care unit (CCU) admissions over a nine-month period (January 2004–September 2004) with acute dyspnea resulting from pulmonary edema. His medical history included a cardiac arrest in 1998 of which exact data were not available. Two and a half weeks before his first admission to our CCU the patient was resuscitated because of an anterior myocardial infarction. He required intubation and mechanical ventilation. He was immediately

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Cited by (8)

Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19
2021, Medicina Clinica
El uso de dispositivos que aportan presión positiva continua en la vía aérea ha demostrado mejoría en diversas patologías que producen insuficiencia respiratoria. En el episodio de pandemia por COVID-19, el uso de estos dispositivos se ha generalizado, pero, debido a la escasez de dispositivos convencionales de presión positiva continua en la vía aérea (CPAP), se han fabricado dispositivos alternativos. El objetivo de este estudio es describir el uso de estos, así como su eficacia.
Se recogen datos de pacientes ingresados por neumonía por COVID-19 en el Hospital de Campaña de IFEMA, así como datos de pacientes con insuficiencia respiratoria y necesidad de soporte ventilatorio.
Estudio realizado sobre un total de 23 pacientes, con fecha de ingreso de entre el 24 de marzo y el 28 de abril en IFEMA. Se empleó CPAP alternativa en cinco pacientes (21,7%), mientras que, en los 18 restantes (78,3%) se usó un soporte ventilatorio con mascarilla reservorio o Ventimask efecto Venturi. Se observó un aumento progresivo de la saturación en aquellos pacientes en los que se empleó CPAP alternativa (de 94% de promedio a 98 y 99% de promedio, tras 30 y 60 minutos con la máscara, respectivamente), aunque este cambio no resultó significativo (p = 0,058 y p = 0,122, respectivamente). De igual manera, no se observó un cambio significativo de frecuencia respiratoria al inicio y al final de la medición en pacientes que usaron CPAP alternativa (p = 0,423) pero sí entre los que no la usaron (p = 0,001). Se observó una mejoría estadísticamente significativa en la variable de saturación de oxígeno/fracción inspirado de oxígeno en los pacientes que usaron CPAP alternativa (p = 0,040).
El uso de estos dispositivos ha ayudado al trabajo ventilatorio de varios pacientes, mejorando sus parámetros de oxigenación. Para observar mejor la evolución de los pacientes sometidos a esta terapia y compararlos con pacientes con otro tipo de soporte ventilatorio, son necesarios más estudios en los que se aleatorice su uso.
The use of devices that provide continuous positive pressure in the airway has shown improvement in various pathologies that cause respiratory failure. In the COVID-19 pandemic episode the use of these devices has become widespread, but, due to the shortage of conventional continuous positive airway pressure (CPAP) devices, alternative devices have been manufactured. The objective of this study is to describe the use of these devices, as well as their efficacy.
Data are collected from patients admitted for pneumonia due to COVID-19 at the IFEMA Field Hospital. Data are collected from 23 patients with respiratory failure and need for ventilatory support.
Study carried out on a total of 23 patients, dated admission to IFEMA. Alternative CPAP was used in five patients (21.7%), while ventilatory support with a reservoir mask or Ventimask Venturi effect was used in the remaining 18 patients (78.3%). A progressive increase in saturation is observed in those patients in whom alternative CPAP was used (from 94% on average to 98 and 99% on average after 30 and 60 minutes with the mask, respectively), although this change was not significant (p = 0.058 and p = 0.122, respectively). No significant change in RF was observed at the beginning and end of the measurement in patients who used alternative CPAP (p = 0.423), but among those who did not use alternative CPAP (p = 0.001). A statistically significant improvement in the variable oxygen saturation / fraction inspired by oxygen is observed in patients who used alternative CPAP (p = 0.040)
The use of these devices has helped the ventilatory work of several patients by improving their oxygenation parameters. To better observe the evolution of patients undergoing this therapy and compare them with patients with other types of ventilatory support, further studies are necessary.
Boussignac CPAP in diagnostic-therapeutic procedures in the critical patient
2011, Medicina Intensiva
La válvula de Boussignac se ha convertido en un elemento a tener en cuenta en el manejo el edema agudo de pulmón. Gracias a su capacidad para generar presión positiva continua en la vía aérea (CPAP) y su simplicidad, su utilización se está extendiendo en los servicios de emergencias y de urgencias y las plantas de hospitalización. Consiste en un pequeño tubo que se coloca sobre el puerto espiratorio de la mascarilla. El flujo (oxígeno/aire) se acelera al pasar a través de cuatro microcanales que existen en la pared de la válvula, y por el principio de la energía en movimiento, consiguen presurizar el árbol bronquial. Su sistema de funcionamiento, no hermético, permite el paso de una sonda a través de ella para asistir al paciente (beber, alimentarse, aspirar, etc.). Ello la capacita para ampliar su utilización en pacientes que, estando en situación límite, necesitan pruebas diagnósticas que pudieran empeorar la situación respiratoria, como los procedimientos endoscópicos. Presentamos a 3 pacientes críticos a los que se administró CPAP con una válvula de Boussignac acoplada a una mascarilla orofacial durante la realización de dos fibrobroncoscopias y una endoscopia digestiva alta. Los 3 casos culminaron con éxito y no se necesitó la intubación orotraqueal.
Boussignac valve is a new resource to consider in acute pulmonary edema cardiogenic management. As it generates positive airways pressure continuous (CPAP) and it is very simple to use, its use is being extended to emergency, urgency and hospitalization ward services. This valve is a small tube placed over the interface expiratory port. The gas flow (oxygen/air) accelerates when it crosses through four microchannels in the valve wall, pressurizing the bronchial tree by the principle of the energy in movement. It has a functioning, not hermetic system, allowing the passage of a catheter through it to help the patient (to drink, to eat, to aspirate, etc.). These characteristics make it possible to extend it use in those patients who, in extreme conditions, need diagnostic tests that could deteriorate their respiratory situation, such as endoscopy procedures. We report three critical patients who received CPAP with a Boussignac valve connected to an orofacial interface, while performing two fibrobronchoscopies and one upper digestive tract endoscopy. All finished successfully and none of them need orotracheal intubation.
Boussignac CPAP in acute respiratory failure
2011, Italian Journal of Medicine
The application of continuous positive airway pressure (CPAP) is one of the most important therapeutic interventions used in patients with acute respiratory failure (ARF) secondary to acute cardiogenic pulmonary edema (ACPE). Thanks to its positive effects on both hemodynamics and ventilation, CPAP improves clinical and blood-gas parameters. Compared with standard oxygen therapy, use of CPAP is associated with decreased mortality and reduced need for intubation in these patients.
This review examines the principles of CPAP, techniques and equipment used to deliver it, and clinical applications. Special emphasis is placed on CPAP delivered with the Boussignac device.
In emergency departments, this simple, lightweight, disposable device has proved to be well tolerated and similar to Venturi-like flow generators in terms of effectiveness. These findings suggest that Boussignac CPAP might be useful for managing ARF in non-critical care areas where other more complicated CPAP equipment (Venturi-like flow generators and ventilators) are not available (for example, in general medical wards).
Out-of-Hospital Continuous Positive Airway Pressure Ventilation Versus Usual Care in Acute Respiratory Failure: A Randomized Controlled Trial. Answers to the September 2008 Journal Club Questions
2009, Annals of Emergency Medicine
Citation Excerpt :
A jet flow of air or oxygen generated in this plastic tube creates a flow-dependent pressure when attached to a high-flow oxygen source. Roughly 15 L per minute of high-flow oxygen from a usual oxygen tank delivers 10 cm H2O of CPAP through the mask.31 The advantages of this device are that it is easy to use and requires only a standard oxygen tank and the disposable facemask unit.
Implementation of Boussignac continuous positive airway pressure in the coronary care unit: Experiences and attitudes
2008, Heart and Lung: Journal of Acute and Critical Care
Boussignac continuous positive airway pressure (BCPAP) delivered by face mask is useful for patients with acute cardiogenic pulmonary edema (ACPE). Although BCPAP is medically effective, we observed that not all suitable patients received it. In this descriptive, prospective, cohort study, we explored the experiences and attitudes of both patients and staff with BCPAP.
Patients were interviewed 12 to 48 hours after treatment with BCPAP. Nurses on the coronary care unit were interviewed on their knowledge, skills, experiences, and opinions concerning BCPAP.
Of 117 patients with ACPE, 87 patients (74%) received BCPAP treatment. It was decided not to administer BCPAP in 30 patients with ACPE (26%). Patients who received BCPAP found that the reduction of dyspnea outweighed any discomfort. Barriers for the use of BCPAP were not related to nurses' skills but to the following: the nurses' belief that BCPAP created major discomfort, the lack of guidelines, the ultimate improvement of oxygenation without BCPAP, and the more labor-intensive treatment.
Overestimation of patient discomfort by nurses and system-related factors impeded the use of BCPAP for all patients with ACPE.
Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system
2013, International Journal of Emergency Medicine

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Letter to the EditorA 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure: A case report

Abstract

Section snippets

Case report

Int J Cardiol

Int J Cardiol

Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema

Am J Cardiol

Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask

N Engl J Med

Letter to the Editor
A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure: A case report