Emergency Medicine: Open Access
Open Access

Abstract

Clinical Experience of Noninvasive Positive Pressure Ventilation in Patients with Acute Cardiogenic Pulmonary Oedema Treated in a Community Hospital in Japan

Eisaku Okuyama, Masami Yano, Seigo Sugiyama, Takashi Miyazaki, Tetsuji Katayama, Keisuke Watanabe, Koichi Kikuta, Daisuke Sato, Keijiro Abe, Kunihiko Matsui, Hisao Ogawa and Natsuki Nakamura

Objective: To review our use of non-invasive positive pressure ventilation (NPPV) for acute cardiogenic pulmonary oedema (ACPO) in the routine clinical management, especially in terms of the timing of endotracheal intubation (ETI) and outcome. Methods: We retrospectively reviewed 61 patients diagnosed with ACPO admitted to our emergency room (ER) or intensive care unit (ICU) and who received NPPV. The reasons for ETI were reviewed, and the intervals between the estimated appropriate time for ETI and the actual time of ETI and in-hospital mortality were recorded. Results: The mortality rate of patients receiving NPPV was 8.2% (five out of 61). Forty-eight patients (78.7%) were successfully weaned off NPPV without ETI, and 13 (21.3%) required ETI. Five of the 13 intubated patients died, but there was no significant difference in the duration of NPPV before ETI between those who survived and those who died. The interval between the estimated appropriate time for ETI and the actual time of ETI was significantly shorter in patients who survived than in those who died (1.9 ± 3.8 hours versus 8.6 ± 5.4 hours, p=0.02). The mortality rate was significantly higher in patients with an interval of longer than 1.8 hours between the estimated appropriate time for ETI and the actual time of ETI (66.7% versus 14.3%, p<0.001). Conclusions: In patients with ACPO receiving NPPV, a delay in performing ETI beyond the appropriate time was significantly associated with increased mortality. The duration of NPPV before ETI was not associated with mortality.