Acidemia does not affect outcomes of patients with acute cardiogenic pulmonary edema treated with continuous positive airway pressure.
Crit Care. 2010 Nov 1;14(6):R196
Authors: Aliberti S, Piffer F, Brambilla AM, Bignamini AA, Rosti VD, Maraffi T, Monzani V, Cosentini R
ABSTRACT: INTRODUCTION: A lack of data exists in the literature in evaluating acidemia on admission as a favourable or negative prognostic factor in patients with acute cardiogenic pulmonary edema (ACPE) treated with non-invasive continuous positive airway pressure (CPAP). The objective of this study was to investigate the impact of acidemia on admission on the outcomes of patients with ACPE treated with CPAP. METHODS: This was a retrospective, observational study of consecutive patients admitted with a diagnosis of ACPE to the Emergency Department of IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy between January 2003 and December 2006, and treated with CPAP on admission. Two groups of patients were identified: subjects with acidemia (acidotic group), and those with a normal pH on admission (controls). The primary endpoint was clinical failure, defined as a switch to BiLevel ventilation, a switch to endotracheal intubation or in-hospital mortality. RESULTS: Among the 378 patients enrolled, 290 (77%) were acidotic on admission. A total of 28 patients (9.7%) in the acidotic group and 8 (9.1%) among controls experienced a clinical failure (OR: 1.069, CI 95%: 0.469-2.438, P=0.875). Survival analysis indicates that, among acidotic patients, the time at which 50% of patient reached the 7.35 threshold was 173 min (95% CI: 153 to 193). Neither acidemia (P=0.205) nor the type of acidosis on admission (respiratory acidosis, P=0.126; metabolic acidosis, P=0.292; mixed acidosis P=0.397) affected clinical failure after adjustment for clinical and laboratory factors in a multivariable logistic regression model. CONCLUSIONS: Neither acidemia nor the type of acidosis on admission should be considered risk factors for adverse outcomes in patients with ACPE treated with CPAP.
PMID: 21040580 [PubMed - as supplied by publisher]