PMID- 10051074
OWN - NLM
STAT- MEDLINE
DCOM- 19990520
LR  - 20201209
IS  - 0342-4642 (Print)
IS  - 0342-4642 (Linking)
VI  - 25
IP  - 1
DP  - 1999 Jan
TI  - Noninvasive pressure support ventilation (NIPSV) with face mask in patients with 
      acute cardiogenic pulmonary edema (ACPE).
PG  - 21-8
AB  - OBJECTIVES: To assess (1) the short-term hemodynamic, respiratory and arterial 
      blood gas effects of NIPSV in patients with ACPE who were likely to require 
      endotracheal intubation, (2) the initial causes of failure and (3) the side 
      effects and the difficulties of this technique. DESIGN: Uncontrolled, prospective 
      clinical study. SETTING: Teaching hospital intensive care unit. PATIENTS: 26 
      consecutive patients with severe ACPE. INTERVENTIONS: Noninvasive ventilation via 
      a face mask, using a pressure support mode (20.5+/-4.7 cm H2O), with an initial 
      fractional inspired oxygen of 93.0+/-16% and a positive end-expiratory pressure 
      of 3.5+/-2.3 cm H2O. The need to intubate the patients within 48 h was considered 
      as a criterion of failure of the procedure. MEASUREMENTS AND RESULTS: Clinical 
      and biological parameters were measured at 15 and 30 minutes, 1 h and 2 h and at 
      1 h and 2 h, respectively. There were 5 (21%) failures and 21 (79%) successes. In 
      both the success and the failure groups, clinical and blood gas parameters 
      improved at the first measure. In the success group, within 15 min of the start 
      of NIPSV, pulse oximetry saturation (SpO2) had increased from 84+/-12 to 96+/-4% 
      (p<0.001), the respiratory rate (RR) had decreased from 36+/-5.3 to 22.4+/-4.9 
      breaths/ min (p<0.0001) and within 1 h the arterial oxygen tension and pH, 
      respectively, had increased from 61+/-14 to 270+/-126 mm Hg (p<0.0001) and from 
      7.25+/-0.11 to 7.34+/-0.07 (p<0.01) and the arterial carbon dioxide tension 
      (PaCO2) had decreased from 54.2+/-15 to 43.4+/-6.4 mm Hg (p<0.01). There were no 
      statistical differences between the success and failure groups for the initial 
      clinical parameters: SpO2, RR, heart rate, mean arterial pressure. The only 
      differences between the success and failure groups were in the PaCO2 (54.2+/-15 
      vs. 32+/-2.1 mm Hg, p<0.001) and the creatine kinase (CPK) (176+/-149 vs. 
      1282+/-2080 IU/l, p<0.05); this difference in CPK activity was related to the 
      number of patients who had an acute myocardial infarction (AMI) (4/5 in the 
      failure group vs. 2/21 in the success group, p<0.05). All patients with AMI in 
      the failure group died. CONCLUSION: Among patients in acute respiratory failure, 
      those with severe ACPE could benefit from NIPSV if they are hypercapnic, but 
      NIPSV should be avoided in those with AMI.
FAU - Rusterholtz, T
AU  - Rusterholtz T
AD  - Service de Reanimation Medicale et Centre Anti Poisons, Hopitaux Universitaires 
      de Strasbourg, France.
FAU - Kempf, J
AU  - Kempf J
FAU - Berton, C
AU  - Berton C
FAU - Gayol, S
AU  - Gayol S
FAU - Tournoud, C
AU  - Tournoud C
FAU - Zaehringer, M
AU  - Zaehringer M
FAU - Jaeger, A
AU  - Jaeger A
FAU - Sauder, P
AU  - Sauder P
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
SB  - IM
CIN - Intensive Care Med. 1999 Jan;25(1):1-2. PMID: 10051070
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Gas Analysis
MH  - Female
MH  - Heart Diseases/*complications/physiopathology
MH  - *Hemodynamics
MH  - Humans
MH  - Male
MH  - Masks
MH  - Middle Aged
MH  - *Positive-Pressure Respiration/methods
MH  - Prospective Studies
MH  - Pulmonary Edema/*etiology/physiopathology/therapy
MH  - *Pulmonary Ventilation
MH  - Respiration
MH  - Respiratory Distress Syndrome/*etiology/physiopathology/therapy
MH  - Treatment Outcome
EDAT- 1999/03/02 00:00
MHDA- 1999/03/02 00:01
CRDT- 1999/03/02 00:00
PHST- 1999/03/02 00:00 [pubmed]
PHST- 1999/03/02 00:01 [medline]
PHST- 1999/03/02 00:00 [entrez]
AID - 10.1007/s001340050782 [doi]
PST - ppublish
SO  - Intensive Care Med. 1999 Jan;25(1):21-8. doi: 10.1007/s001340050782.