title: Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study.
abstract: BACKGROUND
  Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV.
  
  
  METHODS
  219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups.
  
  
  RESULTS
  Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO2ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome.
  
  
  CONCLUSIONS
  Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients.
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland. Electronic address: mari.hongisto@hus.fi.
authors.forename: Mari
authors.initials: M
authors.lastname: Hongisto
authors.affiliation: Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland.
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Tarvasmaki
authors.affiliation: Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona, Spain.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sionis
authors.affiliation: Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Tolppanen
authors.affiliation: Rigshospitalet, Copenhagen University Hospital, Intensive Cardiac Care Unit, Copenhagen, Denmark.
authors.forename: Matias Greve
authors.initials: MG
authors.lastname: Lindholm
authors.affiliation: Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Banaszewski
authors.affiliation: Attikon University Hospital, Heart Failure Clinic and Secondary Cardiology Department, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: University Hospital Brno, Department of Internal Medicine and Cardiology, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: University of Porto, CINTESIS, Department of Cardiology, Porto Medical School, São João Hospital Center, Porto, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Silva-Cardoso
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.affiliation: Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.affiliation: University of Barcelona, Hospital Sant Joan Despi Moisès Broggi, Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.affiliation: Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
mesh_terms: D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends
keywords: Acute coronary syndrome; Acute myocardial infarction; Cardiogenic shock; Mechanical ventilation; Noninvasive ventilation; Ventilation