Document Detail

Risk factors for intubation as a guide for noninvasive ventilation in patients with severe acute cardiogenic pulmonary edema.
MedLine Citation:
PMID:  13680119     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Noninvasive ventilation may reduce the endotracheal intubation rate in patients with acute cardiogenic pulmonary edema. However, criteria for selecting candidates for this technique are not well established. We analyzed a cohort of patients with severe acute cardiogenic pulmonary edema managed by conventional therapy to identify risk factors for intubation. These factors were used as guide for indications for noninvasive ventilation. DESIGN AND SETTING: Observational cohort registry in the ICU and emergency and cardiology departments in a community teaching hospital. PATIENTS:. 110 consecutive patients with acute cardiogenic pulmonary edema, 80 of whom received conventional oxygen therapy. INTERVENTIONS: Physiological measurements and blood gas samples registered upon admission. MEASUREMENTS AND RESULTS: Twenty-one patients (26%) treated with conventional oxygen therapy needed intubation. Acute myocardial infarction, pH below 7.25, low ejection fraction (<30%), hypercapnia, and systolic blood pressure below 140 mmHg were independent predictors for intubation. Conversely, systolic blood pressure of 180 mmHg or higher showed to be a protective factor since only two patients with this blood pressure value required intubation (8%)], both presenting with a pH lower than 7.25. Considering systolic blood pressure lower than 180 mmHg, patients who showed hypercapnia presented a high intubation rate (13/21, 62%) whereas the rate of intubation in patients with normocapnia was intermediate (6/23, 26%). All normocapnic patients with pH less than 7.25 required intubation. No patient with hypocapnia was intubated regardless the level of blood pressure. CONCLUSIONS: Patients with pH less than 7.25 or systolic blood pressure less than 180 mmHg associated with hypercapnia should be promptly considered for noninvasive ventilation. With this strategy about 40% of the patients would be initially treated with this technique, which would involve nearly 90% of the patients that require intubation.
Josep Masip; Joaquim Páez; Montserrat Merino; Sandra Parejo; Francisco Vecilla; Clara Riera; Araceli Ríos; Joan Sabater; Josep Ballús; J Padró
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Publication Detail:
Type:  Journal Article     Date:  2003-09-10
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-10     Completed Date:  2004-02-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1921-8     Citation Subset:  IM    
ICU Department, Hospital Dos de Maig, Consorci Sanitari Integral, Dos de Maig 305, 08025, Barcelona, Spain.
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MeSH Terms
Acute Disease
Blood Gas Analysis
Cohort Studies
Decision Trees
Heart Diseases / complications*
Hospitals, Community
Hospitals, Teaching
Hypercapnia / diagnosis,  etiology,  metabolism
Hypotension / diagnosis,  etiology
Intubation, Intratracheal / adverse effects,  statistics & numerical data*
Middle Aged
Myocardial Infarction / diagnosis,  etiology
Oxygen Inhalation Therapy / methods*
Patient Selection*
Predictive Value of Tests
Pulmonary Edema / etiology,  metabolism,  therapy*
Respiration, Artificial / methods*
Risk Assessment
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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