Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study
Por:
Hongisto, M, Lassus, J, Tarvasmaki, T, Sionis, A, Tolppanen, H, Lindholm, MG, Banaszewski, M, Parissis, J, Spinar, J, Silva-Cardoso, J, Carubelli, V, Di Somma, S, Masip, J, Harjola, VP
Publicada:
1 mar 2017
Resumen:
Background: Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over noninvasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV.
Methods: 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24 h into MV (n= 137; 63%), NIV(n= 26; 12%), and supplementary oxygen (n= 56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups.
Results: Mean age was 67 years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO(2) ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2 were independent predictors of mortality, where as ventilation strategy did not have any influence on outcome.
Conclusions: Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Filiaciones:
Hongisto, M:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Care, Emergency Med, Helsinki, Finland
Lassus, J:
Helsinki Univ Hosp, Heart & Lung Ctr, Div Cardiol, Helsinki, Finland
Tarvasmaki, T:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Care, Emergency Med, Helsinki, Finland
Sionis, A:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Cardiol, Intens Cardiac Care Unit, Barcelona, Spain
Tolppanen, H:
Helsinki Univ Hosp, Heart & Lung Ctr, Div Cardiol, Helsinki, Finland
Lindholm, MG:
Copenhagen Univ Hosp, Rigshosp, Intens Cardiac Care Unit, Copenhagen, Denmark
Banaszewski, M:
Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Parissis, J:
Attikon Univ Hosp, Heart Failure Clin, Athens, Greece
Attikon Univ Hosp, Secondary Cardiol Dept, Athens, Greece
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Silva-Cardoso, J:
Univ Porto, Porto Med Sch, Sao Joao Hosp Ctr, CINTESIS,Dept Cardiol, Oporto, Portugal
Carubelli, V:
Univ & Civil Hosp Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Div Cardiol, Brescia, Italy
Di Somma, S:
Univ Rome Sapienza, Emergency Med StAndrea Hosp, Dept Med Sci & Translat Med, Rome, Italy
Masip, J:
Univ Barcelona, Hosp St Joan Despi Moises Broggi, Crit Care Dept, Consorci Sanitari Integral, Barcelona, Spain
Harjola, VP:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Care, Emergency Med, Helsinki, Finland
Green Published
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