title: Circadian variation of cardiogenic pulmonary oedema.
abstract: BACKGROUND
  Circadian variation of in-hospital acute cardiogenic pulmonary oedema (CPE) with the highest occurrence in the early morning has been reported repeatedly. However, no study evaluating circadian variation of CPE in the field has been published. Therefore, we decided to evaluate the circadian variation of CPE in the Central Bohemian Region of the Czech Republic in the patients treated by regional emergency medical service (EMS) and analyse its association with baseline blood pressure in the field.
  
  
  METHODS
  We extracted all dispatches to CPE cases from EMS database for the period from 1.11.2008 to 30.6.2014 and analysed for circadian variation. We identified the patients presenting with CPE coupled with arterial hypertension (systolic blood pressure >140mmHg) and hypotension (systolic blood pressure <90mmHg) and compared the subgroups (both subgroups include 2744 subjects).
  
  
  RESULTS
  In 4747 episodes of CPE, maximal occurrence was detected in the ninth hour in the morning, representing 7.7% of all CPE episodes (p<0.05). While CPE with hypertension (2463 subjects) reached maximal occurrence also in the ninth hour (7.4% of all cases, p<0.05), CPE with hypotension (281 patients) was most frequent in the fourteenth hour (8.6% of all cases, p<0.05).
  
  
  CONCLUSIONS
  The highest occurrence of CPE was observed in the ninth hour in the morning in our study. Moreover, differences in circadian variation between CPE with hypertension and hypotension were identified. Knowledge of these patterns may have an impact on the logistic of prehospital emergency care and on preventive measures in the patients who have previously undergone CPE.
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic.
authors.forename: Jitka
authors.initials: J
authors.lastname: Callerova
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic; Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Socialni pece 3316 /12A, Usti nad Labem 401 13, Czech Republic; Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic. Electronic address: skulec@email.cz.
authors.forename: Roman
authors.initials: R
authors.lastname: Skulec
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Kucera
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic; 3(rd) Medical Faculty, Charles University in Prague, Ruska 2411/87, Prague 100 00, Czech republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Knor
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic.
authors.forename: Patrik
authors.initials: P
authors.lastname: Merhaut
authors.affiliation: Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, Kladno 272 01, Czech Republic; Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Socialni pece 3316 /12A, Usti nad Labem 401 13, Czech Republic; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic; Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002940:Circadian Rhythm / Q000502:physiology*; D018153:Czech Republic; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000503:physiopathology*
keywords: Cardiogenic pulmonary oedema; Circadian variation; Prehospital