[Predictive factors related to success of non invasive ventilation and mortality in the treatment of acute cardiogenic pulmonary edema].
OBJECTIVE
Recent studies support the use of non invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). We aimed to evaluate the factors related to the success of the technique in patients admitted to an intensive care unit (ICU) with ACPE.


METHODS
An observational prospective study was performed in ICU.199 consecutive patients were enrolled with ACPE at admission who received treatment with NIV and standardized pharmacological treatment. The success of the NIV was achieved when endotracheal intubation was avoided and patients were alive without dyspnea within and 24 hours after discharge from the ICU. Clinical, physiological and gasometric parameters were analyzed at admission and one hour after starting NIV.


RESULTS
Patient's age was 74 years. 43% were male. The SAPS II was 45. 74.4% of the patients were successfully treated with NIV. 12.6% required endotracheal intubation. In a multivariate analysis, the success of the technique (values expressed as odds ratio [95% confidence interval]) was related to: SAPS II (0.95 [0.91-0.99]); the place of admission (6.78 [1.85-24.79]); value of PCO2 at admission (1.05 [1.01-1.09]); PO2/FiO2 index (1.03 [1.01-1.06]) and respiratory frequency (0.91 [0.84-0.99]) within the first hour; SOFA (acute failure organics score) (0.62 [0.49-0.78]); concomittant acute myocardial infarction (AMI) (0.05 [0.01-0.22]) and number of complications (0.17 [0.47-0.65]). The hospital mortality rate was 32.7%. The non intubation order (0.12 [0.04-0.32]) and the success of the technique (100.03 [28.71-348.47]) were related to the hospital mortality.


CONCLUSIONS
The success of NIV in the treatment of ACPE is related to a lower SAPS II, admission at the emergency department, elevated PCO2 at admission, improvement of the PO2/FiO2 index and the respiratory rate within the first hour. The non intubation order and the success of the technique were related to the hospital mortality.
Rodríguez Mulero
Lola
L
Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain. Taclames@hotmail.com
Carrillo Alcaraz
Andrés
A
Melgarejo Moreno
Antonio
A
Renedo Villarroya
Ana
A
Párraga Ramírez
Manuel
M
Jara Pérez
Pedro
P
Millán
María José
MJ
González Díaz
Gumersindo
G
D000208:Acute Disease; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy