title: Acidemia in severe acute cardiogenic pulmonary edema treated with noninvasive pressure support ventilation: a single-center experience.
abstract: In clinical practice, acidotic patients with acute cardiogenic pulmonary edema (ACPE) are commonly considered more severe in comparison with nonacidotic patients, and data on the outcome of these patients treated with noninvasive pressure support ventilation (NIV) are lacking.The present investigation was aimed at assessing whether acidosis on admission (pH < 7.35) was associated with adverse outcome in 65 consecutive patients with ACPE treated with NIV and admitted to our Intensive Cardiac Care Unit (ICCU).In our population, 28 patients were acidotic (28 of 65, 43.1%), whereas 41 patients were not (37 of 65, 56.9%). According to the Repeated Measures General Linear Model, pCO2 values significantly changed throughout the 2-h NIV treatment (P = 0.019) in both groups (P = 0001). In acidotic patients, pCO2 significantly decreased (51.9 ± 15.3 → 47.0 ± 12.8 → 44.8 ± 12.7), whereas they increased in the nonacidotic subgroup (36.8 ± 6.5 → 36.9 ± 7.2 → 37.6 ± 6.4). No difference was observed in intubation rate between acidotic (eight patients, 28.6%) and nonacidotic patients (12 patients, 32.4%) (P = 0.738). In-ICCU mortality rate did not differ between (13 patients, 35.1%) and nonacidotic patients (nine patients, 32.1%) (P = 0.801).Our data strongly suggest that in patients with severe ACPE treated with NIV, the presence of acidosis is not associated with adverse outcomes (early mortality and intubation rates) in these patients.
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Gian F
authors.initials: GF
authors.lastname: Gensini
authors.forename: Claudio
authors.initials: C
authors.lastname: Picariello
authors.forename: Paola
authors.initials: P
authors.lastname: Attanà
authors.forename: Alessio
authors.initials: A
authors.lastname: Mattesini
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
mesh_terms: D000138:Acidosis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D015897:Comorbidity; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods*; D011654:Pulmonary Edema / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen