Document Detail

Short-term noninvasive pressure support ventilation prevents ICU admittance in patients with acute cardiogenic pulmonary edema.
MedLine Citation:
PMID:  12796189     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: Noninvasive ventilation, although effective as treatment for patients with acute cardiogenic pulmonary edema when prolonged for hours, is of limited use in the emergency department (ED). The aim of the study was to determine whether a short attempt at noninvasive pressure support ventilation avoids ICU admittance and to identify lack of response prediction variables. DESIGN: Prospective inception cohort study. SETTING: ED of a university hospital. PATIENTS: Fifty-eight consecutive patients with cardiogenic pulmonary edema who had been unresponsive to medical treatment and were admitted between January 1999 and December 2000. INTERVENTIONS: Pressure support ventilation was instituted through a full-face mask until the resolution of respiratory failure. A 15-min "weaning test" was performed to evaluate clinical stability. Responder patients were transferred to a medical ward. Nonresponding patients were intubated and were admitted to the ICU. MAIN OUTCOME MEASURES: The included optimal length of intervention, the avoidance of ICU admittance, the incidence of myocardial infarction, and predictive lack of response criteria. RESULTS: Patients completed the trial (mean [+/- SD] duration, 96 +/- 40 min). None of the responders (43 patients; 74%) was subsequently ventilated or was admitted to the ICU. Two new episodes of myocardial infarction were observed. Thirteen of 58 patients died. A mean arterial pressure of < 95 mm Hg (odds ratio [OR], 10.6; 95% confidence interval [CI], 1.8 to 60.8; p < 0.01) and COPD (OR, 9.4; 95% CI, 1.6 to 54.0; p < 0.05) at baseline predicted the lack of response to noninvasive ventilation. CONCLUSIONS: A short attempt at noninvasive ventilation is effective in preventing invasive assistance. A 15-min weaning test can identify patients who will not need further invasive ventilatory support. COPD and hypotension at baseline are negative predictive criteria.
Matteo Giacomini; Gaetano Iapichino; Marco Cigada; Aldo Minuto; Rebecca Facchini; Andrea Noto; Elena Assi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  123     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-10     Completed Date:  2003-07-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2057-61     Citation Subset:  AIM; IM    
Istituto di Anestesiologia e Rianimazione dell'Università degli Studi di Milano, Azienda Ospedaliera, Polo Universitario Ospedale San Paolo, Milan, Italy.
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MeSH Terms
Acute Disease
Cohort Studies
Critical Care / methods*
Intensive Care Units
Myocardial Infarction / complications*
Prospective Studies
Pulmonary Edema / etiology,  therapy*
Respiration, Artificial / methods*
Time Factors

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