REVISTA EMERGENCIAS SEMES > ARTÍCULOS
Emergencias 2010; 22: 187-192
Noninvasive ventilation in acute heart failure: patient characteristics and clinical course in cases treated in a hospital emergency department
JOSÉ MANUEL CARRATALÁ
, PERE LLORENS
, BENJAMÍN BROUZET
, JOSÉ CARBAJOSA
, ALEJANDRO R. ALBERT
, ELENA MARTÍNEZ-BELOQUI
, ROGELIO PASTOR
, INMACULADA JIMÉNEZ
, FRANCISCO ROMÁN
Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio. Hospital General Universitario de Alicante, Spain.
Objectives: Our aim was to analyze patient characteristics and clinical course in acute
cardiogenic pulmonary edema (PE) treated with noninvasive ventilation (NIV) in our
hospital emergency department (ED) and to find out factors related to NIV failure and
Methods: Prospective, observational study of all patients with acute CPE requiring NIV
in our ED. We analyzed clinical characteristics and blood gas analyses on admission and
at 60 minutes, type of ventilation applied, destination on discharge, complications, need
for orotracheal intubation, and duration of stay in the ED. Comorbidity was assessed on
the Charlson and Barthel indices. Mortality in the emergency department, on the ward,
or 7 and 21 days after discharge was registered on follow-up.
Results: We studied 133 patients; 69 (51%) were men and the mean (SD) age was 76.2
(10.9) years. Continuous positive airway pressure was used in 60% of the cases.
Symptoms and results of arterial blood gas analysis improved 1 hour after starting NIV.
Meanduration of NIV was 4.25 (2.54) hours. Dry mucus membranes (69%) and
erythematous facial sores (50%) were the most common complications. NIV failed in
9,8% of patients. ED mortality was 3%. Risk factors for death due to heart failure were
age >65 years, blood pressure <120 mm Hg, urea >45 mg/dL, sodium <136 mEq/L,
and respiratory frequency >35 breaths/min on admission. Choice of NIV modality was
not a factor in clinical or blood gas improvements, mortality, or failure of NIV
treatment. Forty-five (33.8%) patients were admitted to the short-stay unit, 35 (26.3%)
to the cardiology ward, 25 (18.8%) to the internal medicine ward, and 7 (5.2%) to the
intensive care unit.
Conclusions: Early application of NIV to treat acute CPE improves symptoms and blood
gases quickly, with few complications and short ED stays. The NIV modality chosen does
not affect mortality or failure of the technique. The possibility of using NIV in all hospital
ED should be considered.
Texto Completo: http://www.semes.org/revista/vol22_3/6_ing.pdf
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