Non-invasive ventilation (NIV) was used to treat 49 patients with acute cardiogenic pulmonary edema in the emergency department. After 1 hour of NIV, patients' respiratory rate, heart rate, blood pressure, and oxygen saturation improved significantly. However, 14 patients (28.6%) still required intubation within 7 days and 10 patients (20.4%) died in the ICU within 10 days. The study concludes that NIV improves survival in acute cardiogenic pulmonary edema patients by reducing mortality and the need for intubation compared to conventional treatment.

1. ROLE OF NON INVASIVE VENTILATION IN
ACUTE CARDIOGENIC PULMONARY OEDEMA IN ED
Dr.Narendra Rajan. T.; Dr. Srihari Cattamanchi; Dr. Nishanth Hiremath. S; Dr. Aravinth. S; Dr. T.V. Ramakrishnan
Sri Ramachandra Medical College & Research Institute, Porur, Chennai – 600116. Tamil Nadu. INDIA.
OBJECTIVES
MATERIALS & METHODS
RESULTS
Dr. Narendra Rajam. T.
Acute cardiogenic pulmonary edema is a
common Medical Emergency. It is a leading
cause of hospitalization, accounting for 6.5
million hospital days each year across the
world. In-hospital mortality from acute
cardiogenic pulmonary edema is high (10 to
20%), especially when it is associated with
acute myocardial infarction. Noninvasive
methods of ventilation can avert tracheal
intubation by improving oxygenation,
reducing the work of breathing, and
increasing cardiac output.
BACKGROUND
•NIPPV was associated with greater
reductions in dyspnea, heart rate,
acidosis, and hypercareduction in mortality
and reducing intubation rate.pnia in ED
and overall
•TROP T was positive in 13 patients
(26.5%).
•Mean BNP was 1108.08 (SD 549.39, P
value 0.017).
•All patients were put on NIV and ABG
repeated after 1 hour, mean pH 7.386,
mean pCo2 38.50, and mean HCo3
21.2239.
•Four patients (8.2%) were again
subjected to NIV and 14 (28.6%) were
intubated within 7 days of ICU care.
•Four patients developed MI after initial
treatment of NIV.
•About 10 patients (20.4%) died in ICU
within 10 days.
•Inclusion: Patients with age >16 years,
clinical diagnosis of APE, pulmonary
edema on chest radiograph, respiratory
rate >20 breaths per minute, and arterial
pH <7.35 were included.
•Methodology: All patients received NIPPV
for minimum of 2 hours. Repeat analyses
of arterial blood gases along with pulse,
respiration, oxygen saturation, andreported
their degree of dyspnea on visual-analogue
blood pressure after 1hour. Patients scale
at recruitment and 1 hour.
•End Point: Primary end point was death or
intubation within 7 days. Secondary end
points were dyspnea, physiological
variables, length of hospital stay and death
within 30 days.
•Statistical Analysis: done using SPSS
ver.17.
•To determine whether noninvasive
ventilation (NIPPV) improves survival in
patients with acute cardiogenic pulmonary
edema (APE) and reduce mortality and
need for intubation.
•Design: A Prospective, analytical study.
•Setting: Accident & Emergency Department
of Sri Ramachandra Medical Centre,
Chennai.
•Duration: 1stJanuary to 31st December 2009.
•A total of 49 patients included 33 males with
mean age of 60.37 years.
•At presentation mean RR was 34.04/min,
mean SpO2 85.98%, mean HR 112.88/min,
mean SBP 143.02 mm Hg, and mean DBP
96.53 mm Hg.
•After 1 hour of NIV mean RR was
24.51/minute, mean SpO2 100%, mean HR
98.84/minute, mean SBP 130 mm of Hg, and
mean DBP 86.98 mm of Hg.
CONCLUSION
ICU Stay in days
20151050
CumSurvival
1.0
0.8
0.6
0.4
0.2
0.0
No-censored
Yes-censored
No
Yes
INTUBATED within 7
days
Survival Functions