Gastric ultrasound-guided noninvasive ventilation for altered hypertensive cardiogenic pulmonary edema: A case report

Background

Gastric ultrasound is mainly used in the preoperative evaluation of patients for aspiration risk assessment. This is accomplished by assessing the gastric antrum, which can be used to calculate the total gastric volume (TGV). We extrapolated this concept to our emergency department to manage cardiogenic pulmonary edema.

Case report

Here, we report a case of a 65-year-old man with comorbidities, namely, hypertension and coronary artery disease, who presented to the emergency department with acute cardiogenic pulmonary edema (ACPE) and had a drop in sensorium after a few minutes of hospital arrival, for whom we resorted to gastric ultrasound-guided noninvasive ventilation (G-NIV) under a sedation cover rather than intubation. We achieved excellent outcomes, and the patient was discharged healthy.

Why should an emergency physician be aware of this?

Although noninvasive ventilation (NIV) is a class 1 indication for ACPE, its role may be limited in altered sensorium or irritable patients. Ideally, these patients should be intubated and mechanically ventilated. However, in resource-limited settings where ventilators are not available, G-NIVs can be used. However, another advantage of G-NIV is that intubation-related complications can be avoided, resulting in early discharge and less morbidity.