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Revista EMERGENCIAS




  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 mortality. 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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