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Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation

BACKGROUND: Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of p...

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Autores principales: Contou, Damien, Fragnoli, Chiara, Córdoba-Izquierdo, Ana, Boissier, Florence, Brun-Buisson, Christian, Thille, Arnaud W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461649/
https://www.ncbi.nlm.nih.gov/pubmed/26059206
http://dx.doi.org/10.1186/s13613-015-0055-y
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author Contou, Damien
Fragnoli, Chiara
Córdoba-Izquierdo, Ana
Boissier, Florence
Brun-Buisson, Christian
Thille, Arnaud W
author_facet Contou, Damien
Fragnoli, Chiara
Córdoba-Izquierdo, Ana
Boissier, Florence
Brun-Buisson, Christian
Thille, Arnaud W
author_sort Contou, Damien
collection PubMed
description BACKGROUND: Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD. METHODS: Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas, all patients treated by non-invasive ventilation (NIV) for severe CPE were included. Hypercapnia was defined as PaCO(2) >45 mmHg and non-rapid favorable outcome was defined as the need for intubation or continuation of NIV for more than 48 h. RESULTS: After excluding 60 patients with underlying CLD or sleep apneas, 112 patients were studied. The rates of intubation and of prolonged NIV were 6.3 % (n = 7) and 21.4 % (n = 24), respectively. Half of the patients (n = 56) had hypercapnia upon admission. Hypercapnic patients were older, more frequently obese, and were more likely to have a respiratory tract infection than non-hypercapnic patients. Hypercapnia had no influence on intubation rate or the need for prolonged NIV. However, patients with severe hypercapnia (PaCO(2) >60 mmHg) needed longer durations of NIV and intensive care unit (ICU) stay than the others. CONCLUSIONS: Among the patients admitted for severe CPE without CLD, half of them had hypercapnia at admission. Hypercapnic patients were older and more frequently obese but their outcome was similar compared to non-hypercapnic patients. Patients with severe hypercapnia needed longer durations of NIV than the others without increase in intubation rate.
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spelling pubmed-44616492015-06-15 Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation Contou, Damien Fragnoli, Chiara Córdoba-Izquierdo, Ana Boissier, Florence Brun-Buisson, Christian Thille, Arnaud W Ann Intensive Care Research BACKGROUND: Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD. METHODS: Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas, all patients treated by non-invasive ventilation (NIV) for severe CPE were included. Hypercapnia was defined as PaCO(2) >45 mmHg and non-rapid favorable outcome was defined as the need for intubation or continuation of NIV for more than 48 h. RESULTS: After excluding 60 patients with underlying CLD or sleep apneas, 112 patients were studied. The rates of intubation and of prolonged NIV were 6.3 % (n = 7) and 21.4 % (n = 24), respectively. Half of the patients (n = 56) had hypercapnia upon admission. Hypercapnic patients were older, more frequently obese, and were more likely to have a respiratory tract infection than non-hypercapnic patients. Hypercapnia had no influence on intubation rate or the need for prolonged NIV. However, patients with severe hypercapnia (PaCO(2) >60 mmHg) needed longer durations of NIV and intensive care unit (ICU) stay than the others. CONCLUSIONS: Among the patients admitted for severe CPE without CLD, half of them had hypercapnia at admission. Hypercapnic patients were older and more frequently obese but their outcome was similar compared to non-hypercapnic patients. Patients with severe hypercapnia needed longer durations of NIV than the others without increase in intubation rate. Springer Paris 2015-06-07 /pmc/articles/PMC4461649/ /pubmed/26059206 http://dx.doi.org/10.1186/s13613-015-0055-y Text en © Contou et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research
Contou, Damien
Fragnoli, Chiara
Córdoba-Izquierdo, Ana
Boissier, Florence
Brun-Buisson, Christian
Thille, Arnaud W
Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title_full Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title_fullStr Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title_full_unstemmed Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title_short Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
title_sort severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461649/
https://www.ncbi.nlm.nih.gov/pubmed/26059206
http://dx.doi.org/10.1186/s13613-015-0055-y
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