ardiogenic pulmonary edema, which is a common complication of acute myocardial infarction, remains a serious clinical problem. 1 If pulmonary edema results in hypoxemia, mechanical ventilation with positive end-expiratory pressure (PEEP) is required. Mechanical ventilation, however, has associated morbidity. The potential benefits of continuous positive airway pressure (CPAP) ventilation include an improvement in oxygenation, a decrease in respiratory work, and a decrease in left ventricular afterload. [2][3][4][5] If CPAP using a mask is utilized in patients with cardiogenic pulmonary edema, the number of patients that later require mechanical ventilation by means of endotracheal intubation can be reduced, while oxygenation and respiratory rate are improved. 6 Further, we have reported that nasal CPAP led to an early decrease in plasma endothelin-1 (ET-1) concentrations in patients with severe cardiogenic pulmonary edema. 7 In practice, however, there are no generally accepted criteria for the initiation of mechanical ventilation in patients with pulmonary edema in the setting of acute myocardial infarction. Accordingly, the primary goal of the present study was to determine the effects of different methods of respiratory management on the hemodynamics, oxygenation, and outcome in patients who developed respiratory failure due to severe cardiogenic pulmonary edema after acute myocardial infarction.
Patients and MethodsThis study was approved by the Committee on Human Patients. Because of the severity of cardiogenic pulmonary edema, no patient was able to give valid informed consent at entry into the study. Therefore, information was provided to the patient's next of kin and their consent was obtained prior to study entry. During the 1-year study period, we prospectively studied 31 of 147 patients with acute myocardial infarction admitted to the coronary care unit (CCU) of our hospital. Of these, one patient with left ventricular free wall rupture and another with ventricular septal perforation were excluded. The remaining patients consisted of 29 adults with respiratory failure due to severe cardiogenic pulmonary edema. All patients with cardiogenic pulmonary edema who had clinical evidence of respiratory distress and a PaO2 below 80 mmHg while receiving 50% oxygen by tight-fitting mask were enrolled.Cardiogenic pulmonary edema was diagnosed if a patient had dyspnea of sudden onset, typical findings on
Effect of Nasal Continuous Positive Airway Pressure on Pulmonary Edema Complicating Acute Myocardial InfarctionJpn Circ J 1998; 62: 553 -558 Shinhiro Takeda, MD; Jun Nejima, MD; Teruo Takano, MD; Kazuhiro Nakanishi, MD; Morimasa Takayama, MD; Atsuhiro Sakamoto, MD*; Ryo Ogawa, MD* Cardiogenic pulmonary edema is a frequent cause of reparatory failure. We investigated the effects of nasal continuous positive airway pressure (CPAP) in patients with severe pulmonary edema associated with acute myocardial infarction. Twenty-nine consecutive patients were divided into 3 groups: firstly, 7 intubated patients who rece...