title: Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation.
abstract: BACKGROUND
  Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD.
  
  
  METHODS
  Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas, all patients treated by non-invasive ventilation (NIV) for severe CPE were included. Hypercapnia was defined as PaCO2 >45 mmHg and non-rapid favorable outcome was defined as the need for intubation or continuation of NIV for more than 48 h.
  
  
  RESULTS
  After excluding 60 patients with underlying CLD or sleep apneas, 112 patients were studied. The rates of intubation and of prolonged NIV were 6.3 % (n = 7) and 21.4 % (n = 24), respectively. Half of the patients (n = 56) had hypercapnia upon admission. Hypercapnic patients were older, more frequently obese, and were more likely to have a respiratory tract infection than non-hypercapnic patients. Hypercapnia had no influence on intubation rate or the need for prolonged NIV. However, patients with severe hypercapnia (PaCO2 >60 mmHg) needed longer durations of NIV and intensive care unit (ICU) stay than the others.
  
  
  CONCLUSIONS
  Among the patients admitted for severe CPE without CLD, half of them had hypercapnia at admission. Hypercapnic patients were older and more frequently obese but their outcome was similar compared to non-hypercapnic patients. Patients with severe hypercapnia needed longer durations of NIV than the others without increase in intubation rate.
authors.affiliation: AP-HP, Réanimation Médicale, Groupe Hospitalier Henri Mondor - Albert Chenevier, Créteil, France, damien.contou@hmn.aphp.fr.
authors.forename: Damien
authors.initials: D
authors.lastname: Contou
authors.forename: Chiara
authors.initials: C
authors.lastname: Fragnoli
authors.forename: Ana
authors.initials: A
authors.lastname: Córdoba-Izquierdo
authors.forename: Florence
authors.initials: F
authors.lastname: Boissier
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille