Changing the Focus in Acute Respiratory Distress Syndrome

Barbas, Carmen Sílvia Valente; Neto, Ary Serpa

doi:10.1097/ccm.0b013e31828c25f2

Cited by 3 publications

(1 citation statement)

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“…Whether this unfavorable prognosis was more related to cardiac or non-cardiac complications (e.g., infections, septic shock, and pulmonary complications of MV) we could not determine. In fact, a cause-and-effect relationship between invasive MV and clinical outcomes could not be established, and our findings might have been influenced by complications of invasive MV such as ventilator-associated pneumonia, delirium and acute respiratory distress syndrome [ 15 , 16 , 17 , 18 ]. Importantly, compared to patients treated without MV, the use of cardiovascular pharmacotherapy was less common in the invasive MV subgroup and reperfusion therapy was less common in both, invasive and non-invasive MV subgroups.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Pesaro

Katz

et al. 2016

PLoS ONE

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PurposePatients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV.MethodsThis was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models.ResultsMechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8–6.2), 13 (11.2–4.7), and 28 (18.0–37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40–1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79–5.26, P<0.001).ConclusionsIn AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.

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