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Clinical Investigations

Non-Invasive Pressure Support Ventilation in Patients with Respiratory Failure due to Severe Acute Cardiogenic Pulmonary Edema

Valipour A.a · Cozzarini W.b · Burghuber O.C.a

Author affiliations

aDepartment of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD Research, Otto Wagner Hospital, Pulmonary Center Vienna, Vienna, and bDepartment of Internal Medicine, District General Hospital of Korneuburg, Korneuburg, Austria

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Respiration 2004;71:144–151

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Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: January 30, 2003
Accepted: September 18, 2003
Published online: March 22, 2004
Issue release date: March – April

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES

Abstract

Background: Recent studies suggest the use of non-invasive pressure support ventilation (NIPSV) in patients with acute cardiogenic pulmonary edema (ACPE). However, it remains unclear whether all patients with ACPE benefit from NIPSV. Objectives: To investigate short-term effects of NIPSV on respiratory, hemodynamic and oxygenation parameters in patients with respiratory failure due to severe ACPE and to identify factors predicting the need for intubation and in-hospital mortality. Methods: In a prospective, uncontrolled, open study, 28 patients admitted with signs and symptoms of severe respiratory distress due to ACPE were given NIPSV in addition to standardized pharmacological treatment. Physiological parameters were obtained before and after NIPSV, and intubation rate and in-hospital mortality were recorded. Results: NIPSV increased arterial oxygenation from paO2 54.2 ± 12.4 to 76.9 ± 12.6 mm Hg (p = 0.0001) and decreased respiratory frequency from 40.1 ± 8.2 to 22.4 ± 4.9 breaths/min (p = 0.0001). Significant improvements were also noted for heart rate, blood pressure and the paO2/FiO2 ratio. Four patients (14%) required intubation despite NIPSV. Patients who required intubation had lower paCO2 levels (p = 0.0002), lower serum bicarbonate concentrations (p = 0.04) and lower systolic blood pressure (p = 0.045) than patients who were successfully treated with NIPSV. Eight patients (28.5%) died during hospitalization. In patients with a paCO2 ≤35 mm Hg on admission, the in-hospital mortality was 87%, but in patients with a paCO2 >35 mm Hg the in-hospital mortality was 6%. Conclusions: NIPSV improves oxygenation and alleviates respiratory distress in patients with respiratory failure due to severe ACPE. However, a subgroup of patients with hypocapnia on admission might have a poor prognosis, with a higher risk of intubation and in-hospital mortality.

© 2004 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: January 30, 2003
Accepted: September 18, 2003
Published online: March 22, 2004
Issue release date: March – April

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES


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