title: Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema.
abstract: Adaptive servo-ventilation (ASV) at home has been used for patients with chronic heart failure. However, its effect on acute cardiogenic pulmonary edema (ACPE) is not clear. The aim of this study was to elucidate the effect of ASV use in the emergency room in patients with ACPE.
  
  
  
  We enrolled 198 consecutive patients with ACPE. Eighty patients received standard therapies, such as oxygen inhalation and vasodilators (conventional therapy group), and 118 received ASV in addition to standard therapy (ASV therapy group). ASV was initiated in the emergency room immediately after diagnosis. The procedure was switched over from ASV to endotracheal intubation (ETI) when oxygenation was insufficient.
  
  
  
  The ETI rate in the ASV therapy group was significantly lower than that in the conventional therapy group (3% vs. 21%, p<0.01). The intensive care unit and/or high care unit length of stay in the ASV therapy group was also significantly shorter than that in the conventional therapy group (1.9±2.1 days vs. 5.3±6.8 days, p<0.01). Consequently, the hospitalization period in the ASV therapy group was shorter than that in the conventional therapy group (19.3±11.0 days vs. 26.3±16.6 days, p<0.01).
  
  
  
  In patients with ACPE, rapid introduction of ASV in the emergency room reduces the need for ETI and decreases the hospitalization period.
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kinoshita
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan. Electronic address: c-hokayama@eph.pref.ehime.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Okayama
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Kawamura
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shigematsu
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kawata
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Hiasa
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Tadakatsu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kazatani
mesh_terms: D000208:Acute Disease; D000368:Aged; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000628:therapy*; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute cardiogenic pulmonary edema; Adaptive servo-ventilation; Endotracheal intubation; Noninvasive positive pressure ventilation