[Spontaneous positive end-expiratory pressure ventilation in elderly patients with cardiogenic pulmonary edema. Assessment in an emergency admissions unit].
OBJECTIVE
Intubation and ventilatory assistance are often required in patients presenting severe hypoxemic respiratory distress, but may be contraindicated in elderly subjects due to an underlying condition. The aim of this study was to assess the feasibility, acceptability and contribution of early assistance with spontaneous positive end-expiratory pressure ventilation for elderly subjects admitted to an emergency unit for acute respiratory distress due to cardiogenic pulmonary edema.


METHODS
In our emergency admission unit, all patients with life-threatening hypoxemic respiratory distress are initially assisted with noninvasive spontaneous positive end-expiratory pressure ventilation using a standardized commercial device. We retrospectively analyzed the the files of all patients aged over 70 years who were treated with this standard protocol for cardiogenic pulmonary edema from April 1996 through September 1997.


RESULTS
During the study period, 36 patients aged over 70 years required ventilatory assistance according to the standard protocol. Intubation was not reasonable in most of the patients (n = 30). After 1 hour of ventilation, none of the patients developed clinical signs of life-threatening distress. Blood gases demonstrated improved oxygenation (AEPO2 = +184.9 +/- 105.4 mmHg; p < 0.000001). Thirty-two patients were considered to be cured (88.9%) and were discharged; the cardiovascular condition was fatal in 4 patients (11.1%).


CONCLUSIONS
The rapid improvement in clinical signs and blood gases as well as the final outcome suggests that early assistance with spontaneous positive end-expiratory pressure ventilation is warranted at admission for elderly patients with respiratory distress due to cardiogenic pulmonary edema. Compared with a control group of hospitalized patients cared for during the preceding year and who were not treated with the standard protocol, we also demonstrated a clear improvement in mortality (11% versus 20%).
L'Her
E
E
Réanimation et Urgences médicales, CHU de la Cavale Blanche, Brest.
Duquesne
F
F
Paris
A
A
Mouline
J
J
Renault
A
A
Garo
B
B
Boles
J M
JM
D000289:Admitting Department, Hospital; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods; D011654:Pulmonary Edema / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
Ventilation spontanée en pression expiratoire positive au cours de l'oedème pulmonaire cardiogénique de la personne âgée. Etude dans un service d'accueil et d'urgence.