role of non invasive ventilation in acute cardiogenic pulmonary oedema in ed
TRANSCRIPT
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 days20151050
Cu
m S
urv
iva
l
1.0
0.8
0.6
0.4
0.2
0.0
No-censoredYes-censoredNoYes
INTUBATED within 7 days
Survival Functions