Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema

• Published in: Journal of cardiology Vol. 69; no. 1; pp. 308 - 313
• Main Authors: Kinoshita, Masaki, MD, Okayama, Hideki, MD, FJCC, Kawamura, Go, MD, Shigematsu, Tatsuya, MD, Takahashi, Tatsunori, MD, Kawata, Yoshitaka, MD, Hiasa, Go, MD, FJCC, Yamada, Tadakatsu, MD, Kazatani, Yukio, MD, FJCC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2017
• Subjects: Acute cardiogenic pulmonary edema; Acute Disease; Adaptive servo-ventilation; Aged; Cardiovascular; Emergency Treatment - methods; Endotracheal intubation; Female; Humans; Intensive Care Units - statistics & numerical data; Intubation, Intratracheal - methods; Intubation, Intratracheal - statistics & numerical data; Length of Stay; Male; Middle Aged; Noninvasive positive pressure ventilation; Oxygen Inhalation Therapy - methods; Positive-Pressure Respiration - methods; Pulmonary Edema - etiology; Pulmonary Edema - therapy; Shock, Cardiogenic - therapy; Time-to-Treatment; Treatment Outcome; Acute cardiogenic pulmonary edema; Noninvasive positive pressure ventilation; Adaptive servo-ventilation; Endotracheal intubation
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2016.05.015

Abstract Background Adaptive servo-ventilation (ASV) at home has been used for patients with chronic heart failure. However, its effect on acute cardiogenic pulmonary edema (ACPE) is not clear. The aim of this study was to elucidate the effect of ASV use in the emergency room in patients with ACPE. Methods We enrolled 198 consecutive patients with ACPE. Eighty patients received standard therapies, such as oxygen inhalation and vasodilators (conventional therapy group), and 118 received ASV in addition to standard therapy (ASV therapy group). ASV was initiated in the emergency room immediately after diagnosis. The procedure was switched over from ASV to endotracheal intubation (ETI) when oxygenation was insufficient. Results The ETI rate in the ASV therapy group was significantly lower than that in the conventional therapy group (3% vs. 21%, p < 0.01). The intensive care unit and/or high care unit length of stay in the ASV therapy group was also significantly shorter than that in the conventional therapy group (1.9 ± 2.1 days vs. 5.3 ± 6.8 days, p < 0.01). Consequently, the hospitalization period in the ASV therapy group was shorter than that in the conventional therapy group (19.3 ± 11.0 days vs. 26.3 ± 16.6 days, p < 0.01). Conclusion In patients with ACPE, rapid introduction of ASV in the emergency room reduces the need for ETI and decreases the hospitalization period.