THE USE OF NON-INVASIVE VENTILATION IN ACUTE HEART FAILURE

Abstract

Heart failure (HF) is a global public health problem, and its acute decompensation often culminates in cardiogenic acute pulmonary edema (CAPE), a medical emergency with high morbidity and mortality. Non-invasive ventilation (NIV) has emerged as a fundamental intervention in the management of these patients. Objective: To synthesize the clinical evidence and current guideline recommendations on the efficacy and application of NIV in acute heart failure. Method: This is an integrative literature review, with searches in the LILACS, SciELO, and MEDLINE/PubMed databases, covering the period from 2019 to 2025. The search strategy used the descriptors ("Insuficiência Cardíaca" OR "Heart Failure") AND ("Ventilação Mecânica Não Invasiva" OR "Noninvasive Ventilation" OR "CPAP" OR "BiPAP"). Original studies, systematic reviews, meta-analyses, and clinical guidelines addressing the use of NIV in adults with acute HF were included. Editorials, letters to the editor, and studies focusing exclusively on pediatric populations were excluded. The selection process, from an initial universe of 127 articles, involved screening titles and abstracts, followed by a full-text review of 40 articles, resulting in 17 studies for the final synthesis. Results: The analysis of the studies showed that NIV, compared to standard medical treatment, significantly reduces the need for orotracheal intubation (51% reduction) and hospital mortality (35% reduction). The benefits are mediated by physiological effects, such as the reduction of left ventricular preload and afterload and the rapid improvement of gasometric parameters. The literature corroborates the safety of the therapy and indicates no significant differences in primary outcomes between the CPAP and BiPAP modalities. However, the need for NIV also proved to be a marker of greater disease severity and poorer prognosis at 180 days. Final Considerations: NIV is an effective and safe therapy, considered the gold standard in the treatment of CAPE. The physiotherapist plays a central role in the application and monitoring of the therapy, aiming to optimize the patient's clinical and hemodynamic outcomes.