[Clinical study of mechanical ventilation in acute cardiogenic pulmonary edema patients].
OBJECTIVE
To study the application of mechanical ventilation in acute cardiogenic pulmonary edema (ACPE), and compare the changes in hemodynamics between continuous positive airway pressure proportional pressure support (CPAP-PPS) with continuous positive airway pressure-pressure support ventilation (CPAP-PSV).


METHODS
Non-invasive and invasive ventilation were performed in 77 ACPE patients. At the initiation of invasive ventilation and the phase of low assist ventilation in 61 patients who were treated with mechanical ventilation longer than 24 hours, hemodynamics was monitored by partial CO(2) rebreathing method (non-invasive cardiac output, NICO) cardiopulmonary management system, and then compared the changes in the two kinds of ventilation under medicinal intervention.


RESULTS
Among 33 of 61 ACPE patients underwent non-invasive ventilation, 24 were successful, and the ratio was 72.7%. Among 33 patients with invasive ventilation (including 5 in whom ventilation was switched to non-invasive mode), 11 failed. Biphasic positive airway pressure/pressure support ventilation (BIPAP/PSV) was used in pressure controlled ventilation, with high pressure (Phigh) 16-24 cm H(2)O (1 cm H(2)O=0.098 kPa), time of high pressure (Thigh) 1.5 seconds, positive end expiratory pressure (PEEP) 6-15 cm H(2)O, fractional concentration of inspired oxygen (FiO(2)) 0.5, cardiac output (CO)/cardiac index (CI) was significantly improved compared with those of initial ventilation in successful ones in invasive group, and the improvement was more significant in PPS compared with PSV in low assist ventilation (all P<0.001). Those in whom invasive ventilation was failed had a low CI (<1.5 L.min(-1).m(-2)) even under drug intervention.


CONCLUSIONS
Hemodynamic monitoring should be performed when medicinal intervention and non-invasive/invasive ventilation are given to ACPE patients. Pressure controlled ventilation is recommended, and PEEP should be individualized (normally 6-15 cm H(2)O). Spontaneous ventilation should be restored as soon as possible, CPAP-PPS mode is practicable in patients in whom weaning of mechanical ventilation is difficult.
Zhan
Chun
C
Department of Intensive Care Unit, Tianjin Third Central Hospital, Tianjin, 300170, China.
Qin
Ying-zhi
YZ
Zhang
Na-xin
NX
Xu
Lei
L
Zhang
Wei
W
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004489:Edema, Cardiac / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome