Carvalho Luísa, Carneiro Rui, Freire Elga, Pinheiro Paulo, Aragão Irene, Martins Alfredo
Serviço de Medicina 1 do Hospital Geral de Santo António, Porto, Portugal.
Rev Port Cardiol. 2008 Feb;27(2):191-8.
Bilevel positive pressure (BiPAP) non-invasive ventilation (NIV) is frequently used in our emergency department (ED), as an adjuvant in the treatment of acute cardiogenic pulmonary edema (ACPE) to reduce the need for tracheal intubation (TI) in these patients. The purpose of our study was to evaluate the safety of NIV in patients with ACPE in our ED, used by a group of physicians outside the intensive care unit (ICU), by comparing our results with previously published results. We also wanted to identify possible additional advantages of NIV in the treatment of acpe. We recorded clinical and physiological data before and after NIV of all patients with diagnosis and treatment of ACPE in our ED and for whom NIV was ordered as adjuvant treatment, between July 2004 and February 28 2005. During this period, NIV was ordered in 17 patients with ACPE. The mean ventilation pressures used were p(INSP) 16.5 +/- 5 cm H2O and p(exp) 8.8 +/- 4 cm H2O. none of the patients refused NIV. In six patients NIV was not initiated immediately together with medical therapeutics. one patient required Ti and the other 16 (94%) improved after NIV. After the acpe episode had resolved, fourteen patients (82%) were eventually discharged from hospital whereas 3 (18%) died during hospitalization. We observed a statistically significant improvement after one hour of NIV in respiratory and pulse rate, arterial pH, PaCO2 and peripheral blood O2 saturation. Despite the small sample size, these results suggest that it is possible to use NIV in the treatment of ACPE outside the ICU, without increasing the risks of TI or decreasing efficacy. In these cases NIV probably accelerates clinical resolution and relieves symptoms.
双水平气道正压通气（BiPAP）无创通气（NIV）在我们急诊科经常使用，作为治疗急性心源性肺水肿（ACPE）的辅助手段，以减少这些患者气管插管（TI）的需求。我们研究的目的是通过将我们的结果与先前发表的结果进行比较，评估在我们急诊科由重症监护病房（ICU）以外的一组医生使用NIV治疗ACPE患者的安全性。我们还想确定NIV在治疗ACPE方面可能存在的其他优势。我们记录了2004年7月至2005年2月28日期间在我们急诊科诊断和治疗ACPE且被医嘱使用NIV作为辅助治疗的所有患者在NIV治疗前后的临床和生理数据。在此期间，有17例ACPE患者被医嘱使用NIV。使用的平均通气压力为吸气压力（p(INSP)）16.5±5 cm H₂O，呼气压力（p(exp)）8.8±4 cm H₂O。没有患者拒绝NIV。6例患者未与药物治疗同时立即开始NIV。1例患者需要气管插管，其他16例（94%）在NIV治疗后病情改善。ACPE发作缓解后，14例患者（82%）最终出院，3例（18%）在住院期间死亡。我们观察到NIV治疗1小时后呼吸频率、脉搏率、动脉pH值、PaCO₂和外周血氧饱和度有统计学意义的改善。尽管样本量较小，但这些结果表明在ICU以外使用NIV治疗ACPE是可行的，不会增加气管插管的风险或降低疗效。在这些情况下，NIV可能会加速临床缓解并缓解症状。
