Dieperink Willem, Jaarsma Tiny, van der Horst Iwan C C, Nieuwland Wybe, Vermeulen Karin M, Rosman Hanka, Aarts Leon P H J, Zijlstra Felix, Nijsten Maarten W N
Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 P.O. Box 30,001, 9700 RB Groningen, The Netherlands.
BMC Cardiovasc Disord. 2007 Dec 20;7:40. doi: 10.1186/1471-2261-7-40.
Continuous positive airway pressure (CPAP) treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP) system that does not need a mechanical ventilator.
BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of < 95% while receiving oxygen, were included in a prospective BCPAP group that was compared with a historical control group that received conventional treatment with oxygen alone.
During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78%) were treated at the coronary care unit of which 66 (61%) were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47%) needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately euro 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment.
At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings).
持续气道正压通气（CPAP）治疗急性心源性肺水肿在急性心脏护理中可带来重要益处。然而，冠心病监护病房通常未配备相关设备，且其工作人员也未接受足够的使用机械通气机进行CPAP治疗的培训。因此，我们在冠心病监护病房环境中研究了无需机械通气机的简易布西尼亚克面罩 - CPAP（BCPAP）系统的可行性及治疗效果。
在一个工作人员无CPAP治疗经验的冠心病监护病房引入BCPAP。所有因急性心源性肺水肿被转运至我院、呼吸频率>25次/分钟且在吸氧时外周动脉血氧饱和度<95%的连续患者，被纳入前瞻性BCPAP组，并与仅接受常规吸氧治疗的历史对照组进行比较。
在为期2年的前瞻性BCPAP研究期间，108例患者因急性心源性肺水肿入院。其中84例（78%）在冠心病监护病房接受治疗，其中66例（61%）接受了BCPAP治疗。在对照期，1年内有66例患者入院，其中31例（47%）在重症监护病房需要呼吸支持。BCPAP治疗与缩短住院时间以及减少因插管和机械通气而转入重症监护病房的次数相关。与传统治疗相比，BCPAP策略使每位患者总体节省约3800欧元。
在冠心病监护病房，BCPAP治疗急性心源性肺水肿可行、具有医学有效性且具有成本效益。观察指标包括死亡率、冠心病监护病房住院时间和总住院时间、通气支持需求以及成本（节省情况）。
