SESSION TITLE: Critical Care 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The heart and lungs are closely related to each other by their anatomical connections and its role in systemic oxygenation. When treating critically ill patients, hemodynamic instability plays a major role when making decisions. As well invasive managements will often take place, as when mechanical ventilation is necessary. We here report successful management using airway pressure release ventilation (APRV) for pulmonary edema in which evident improvement in cardiac index. Airway pressure release ventilation (APRV) is a relatively old mode of mechanical ventilation, however it’s beneficial physiologic effects are not well documented. The outcomes of positive pressure ventilation on hemodynamic parameters are very multifarious. They play a junctional role between intrathoracic pressure, venous return to the heart and subsequently vascular resistance. Cardiogenic pulmonary edema is a fatal event in decompensated congestive heart failure. Mechanical ventilation is often not necessary in patients with severe pulmonary edema not responding to aggressive diuretic therapy. However, sometimes it’s necessary to further maintain adequate alveolar oxygen exchange, in view of increase permeability caused by edema. CASE PRESENTATION: The patient was a 64-year-old woman, with a history of heart failure with decrease ejection fraction, hypertension and diabetes mellitus, admitted to the emergency department with with flash cardiogenic pulmonary edema. Upon observation in the emergency the patient had intense dyspnea with decrease oxygen saturation and adequate blood pressures; in which patient require mechanical ventilation that was initially started in continuous mechanical ventilation with 8 ml/kg tidal volume, PEEP of 8, Fio2 of 100% and respiratory rate of 12. After patient stabilization in the emergency department a focused cardiac ultrasound examination was performed using the velocity time integral (VTI) and left ventricular outflow tract (LVOT). Values with continuous mechanical ventilation were 12.0 cm (LVOT VTI) and 2.06 cm (LVOT) Diameter consistent with a cardiac output 3.9 L/min, cardiac index 2.1 L/min/m2 and approximately 40 mL of stroke volume. Values with APRV were 15.0 cm (LVOT VTI) and 2.10 (LVOT) diameter consistent with a cardiac output 5.1 L/min, cardiac index 2.7 L/min/m2 and approximately 52 mL of stroke volume. We here report successful management using airway pressure release ventilation (APRV) for pulmonary edema in which evident improvement in hemodynamics wee seen. DISCUSSION: During spontaneous breathing, the pleural pressure diminishes, leading to a decrease in the intra thoracic and right sided heart pressures thus increasing pre load and consequently improving cardiac output. Multiple hemodynamic and systemic benefits had been studied with APRV. CONCLUSIONS: An organized ventilatory cycle and cardiovascular system have profound effect on hemodynamics. Reference #1: Cournaud A, Motley HL, Werko L, et al. Physiologic studies of theeffect of intermittent positive pressure breathing on cardiac output inman. Am J Physiol. 1948;152:162–174. Reference #2: Dinh, Vi Am et al. cardiac index with a focused cardiac ultrasound examination in the ED.The American Journal of Emergency Medicine , Volume 30 , Issue 9 , 1845 - 1851 Reference #3: Cherpanath TGV, Lagrand WK, Schultz MJ, Groeneveld ABJ. Cardiopulmonary interactions during mechanical ventilation in critically ill patients. Netherlands Heart Journal. 2013;21(4):166-172. https://doi.org/10.1007/s12471-013-0383-1. DISCLOSURES: No relevant relationships by Christian Castillo Latorre, source=Web Response No relevant relationships by Ricardo Fernandez, source=Web Response Speaker/Speaker's Bureau relationship with Medtronic Please note: $5001 - $20000 Added 03/06/2018 by Ricardo Hernandez, source=Web Response, value=Honoraria No relevant relationships by Hiram Jose Maldonado Quintana, source=Web Response No relevant relationships by Kelvin Rivera Manzano, source=Web Response