1999 OPEN FORUM Abstracts

EMERGENCY DEPARTMENT VENTILATION WITHOUT INTUBATION FOR TREATMENT OF ACUTE PULMONARY EDEMA

Herbert Wigder, MD, Daniel Mazzolini Jr., RRT, Paul Hoffmann, RRT, Arvey Stone, MD, Douglas Propp, MD, James Clark, MD, Stephen Scholly, MD. From the Departments of Emergency Medicine, Respiratory Care Services and Pulmonary Medicine, Lutheran General Hospital, Park Ridge, Illinois.

Objective: To assess acute cardiogenic pulmonary edema (ACPE) patient response to ventilatory support provided by non-invasive positive pressure ventilation (NPPV).

Methods: During 1998, a convenience sample of adult patients presenting to the emergency department (ED) with ACPE were entered in the study. All patients received routine therapy consisting of oxygen, nitrates and diuretics. Study patients were started on full mask NPPV using a Mallinckrodt Inc. 7200Ò ventilator with settings of 10 cm H₂O pressure support, 5 cm H₂O PEEP and FiO₂ 100%. Pressure support was titrated to achieve a tidal volume of 5-7 mL/kg, and PEEP titrated to achieve an oxygen saturation (SpO₂) > 90%. Outcome measures included endotracheal intubation (ETI), SpO₂, arterial blood gases (ABG), Borg dyspnea score and vital signs.

Results: Eighteen patients with mean age 76.6 ± 14.7 years were entered in the study. Initial mean values on FiO₂ 100% by non-rebreather mask: SpO₂ 89 ± 11%, pH 7.17 ± .13, PaO₂ 74 ± 27 mm Hg, PaCO₂ 60 ± 19 mm Hg, Borg score 7.9 ± 1.4, and respiratory rate (RR) 38 ± 7. At 60 minutes following initiation of NPPV the mean values showed: SpO₂ 98 ± 2%, pH 7.28 ± .09 (p= .007), PaO₂ 187 ± 122 mm Hg, PaCO₂ 45 ± 16 mm Hg, Borg score 3.8 ± 2.3 (p= .002), and RR 29 ± 9 (p= .004). NPPV duration ranged from 30 minutes to 36 hours (median 3 hours). There were no problems with patient tolerance of NPPV. Sixteen patients (89%) improved allowing cessation of NPPV. Two patients required ETI (both had concomitant severe COPD). There were no complications of NPPV. Conclusion: Ventilatory support without ETI using a full face mask and conventional volume ventilator is an effective treatment for ACPE. Use of NPPV in the emergency department setting is feasible and may help prevent ETI.

OF-99-068