Abstract
IntroductionA lack of data exists in the literature evaluating acidemia on admission as a favorable or negative prognostic factor in patients with acute cardiogenic pulmonary edema (ACPE) treated with non-invasive continuous positive airway pressure (CPAP). The objective of the present study was to investigate the impact of acidemia on admission on outcomes of ACPE patients treated with CPAP.MethodsThis was a retrospective, observational study of consecutive patients admitted with a diagnosis of ACPE to the Emergency Department of IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy, between January 2003 and December 2006, treated with CPAP on admission. Two groups of patients were identified: subjects with acidemia (acidotic group), and those with a normal pH on admission (controls). The primary endpoint was clinical failure, defined as switch to bi-level ventilation, switch to endotracheal intubation or inhospital mortality.ResultsAmong the 378 patients enrolled, 290 (77%) were acidotic on admission. A total of 28 patients (9.7%) in the acidotic group and eight patients (9.1%) among controls experienced a clinical failure (odds ratio = 1.069, 95% confidence interval = 0.469 to 2.438, P = 0.875). Survival analysis indicates that, among acidotic patients, the time at which 50% of patients reached the 7.35 threshold was 173 minutes (95% confidence interval = 153 to 193). Neither acidemia (P = 0.205) nor the type of acidosis on admission (respiratory acidosis, P = 0.126; metabolic acidosis, P = 0.292; mixed acidosis, P = 0.397) affected clinical failure after adjustment for clinical and laboratory factors in a multivariable logistic regression model.ConclusionsNeither acidemia nor the type of acidosis on admission should be considered risk factors for adverse outcomes in ACPE patients treated with CPAP.
Highlights
A lack of data exists in the literature evaluating acidemia on admission as a favorable or negative prognostic factor in patients with acute cardiogenic pulmonary edema (ACPE) treated with non-invasive continuous positive airway pressure (CPAP)
Acidotic population Among the 419 ACPE patients treated with CPAP who were enrolled during the study period, the pH value within 15 minutes from admission was not available in 23 patients, while 18 patients were excluded because of alkalemia on admission
The present study indicates that acidemia on admission is not a risk factor for adverse outcomes in ACPE patients treated with CPAP
Summary
A lack of data exists in the literature evaluating acidemia on admission as a favorable or negative prognostic factor in patients with acute cardiogenic pulmonary edema (ACPE) treated with non-invasive continuous positive airway pressure (CPAP). International guidelines suggest the use of non-invasive continuous positive airways pressure (CPAP) as first-line intervention in patients with acute cardiogenic pulmonary edema (ACPE) [1]. CPAP has proven to be easier to use, quicker to implement in clinical practice and to carry smaller associated costs in comparison with noninvasive ventilation (NIV) [2]. In light of these findings, CPAP has been used to treat ACPE patients. In view of this consideration, the largest clinical trial that has evaluated CPAP and NIV in ACPE patients enrolled acidotic patients [10]
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