Non-invasive mechanical ventilation in patients with acute cardiogenic pulmonary edema.
OBJECTIVE
To evaluate the use of noninvasive mechanical ventilation (NIMV) in patients with acute cardiogenic pulmonary edema.


METHODS



METHODS
prospective study.


METHODS
Emergency Department at a University hospital.


METHODS
84 patients with acute respiratory distress due to pulmonary edema. Interven-tions: NIMV, using a pressure support mode and positive end-expiratory pressure (PEEP). A "weaning test" to evaluate clinical stability.


METHODS
heart rate, arterial blood pressure, respiratory rate, arterial blood gases, electrocardiogram and incidence of myocardial infarction before and after NIMV. Mortality and duration of hospital stay were also considered.


RESULTS
A total of 84 patients received NIMV with 14+/-3.6 cm H2O pressure support over PEEP of 8.3+/-2.1 cm H2O and FiO2 1. At the end of the study period, 16 patients (19%) were considered "non responders" and required invasive ventilation; 62 patients (74%) were considered "responders" and subsequently transferred to the medical ward. The hospital mortality was 14% and 25% in the "responder" and "non responder" groups, respectively; the length of stay was 15.7+/-10.1 days in the "responder" group vs 16+/-10.6 days in the "non responder" group. We never found new episodes of myocardial infarction related to NIMV. The only significant difference between "responder" and "non responder" patients was arterial blood pressure.


CONCLUSIONS
We hypothesize that "non responder" patients, characterized by blood pressure values lower than "responders", are less "cardiocompetent" and thus unable to cope with the increased work of breathing. NIMV avoided Intensive Care Unit admission for 74% of the observed patients.
Minuto
A
A
Division of Anesthesiology and Resuscitation, University of Milan, San Paolo" Hospital, Milan, Italy.
Giacomini
M
M
Giamundo
B
B
Tartufari
A
A
Denkewitz
T
T
Marzorati
S
S
Palandi
A
A
Stabile
L
L
Iapichino
G
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors