الفهرس 
ACUTE CARDIOGENIC PULMONARY EDEMAOnly 14 pages are availabe for public view
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Abstract
Continuous positive airway pressure ventilation (CPAP) through venturi mask has been widely used especially in North America, Europe and Australasia to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema.
Continuous positive airway pressure ventilation (CPAP) is ventilatory support that is given without establishing endotracheal intubation. CPAP avoid complication of endotracheal tube and invasive mechanical ventilation, preserving the patient’s ability to speak, eat, and cough reflex, reduces the need for sedation, potential airway trauma, and the risk of ventilator associated pneumonia.
Acute cardiogenic pulmonary edema (ACPE) is a common medical emergency and a common cause of acute respiratory distress among patients presenting to intensive care units and associated with high mortality especially when associated with acute myocardial infarction.
This study aims at determining whether Continuous positive airway pressure ventilation (CPAP) of immediate benefit in adults with acute cardiogenic pulmonary edema compared to standard oxygen therapy through face mask and whether there are important differences in outcome associated with this method of treatment regarding hospital mortality, rate of endotracheal intubation and intensive care unit (ICU) length of stay.
In this study, 62 patients admitted at critical care unit of the Ain Shams University Hospitals with acute cardiogenic pulmonary edema. Patients divided into two groups. group I: included 31 patients with acute cardiogenic pulmonary edema receive CPAP with (PS 10cm h2o, PEEP 5cm h2o). group II: included 31 patients with acute cardiogenic pulmonary edema receive Oxygen therapy by face mask. Both groups are compared regarding the following parameter: Pao2, Pco2, respiratory rate and Spo2 on admission, 1-hour and 2-hours, post intervention and after discontinuation of treatment. Both groups were compared regarding the rate of endotracheal intubation, ICU length of stay and hospital mortality.
In this study, the baseline characteristics of the patient on admission, are similar in both treatment groups (CPAP or oxygen therapy) regarding age (57.11±2.33, versus 56.41 ± 2.54 with P = 0.89), gender (male gender 38 versus female gender 24), disease prevalence on admission (hypertension, diabetes mellitus, ischemic heart disease, congestive heart failure and valvular heart disease), hemodynamics on admission, oxygen saturation and arterial blood gases, and there is no statistically significant difference between both groups allowing only one different variable between two group, which is usage of CPAP in one group and oxygen therapy in the other one.
This study showed that the respiratory distress was markedly improved in CPAP group compared to oxygen therapy group by face mask as shown in respiratory rate after institution of CPAP (48.31±4.29, 35.84±5.30).
In this study, as regarding to ICU length of stay, there was reduction in the intensive care unit length of stay in patient received CPAP compared to length of stay in standard oxygen treatment received group (2.48 ± 0.51 vs. 4.03± 0.65).
This study show that there is reduction in rate of intubation in group I with CPAP compared with group II with oxygen therapy by face mask.
This study concluded that in patients with acute cardiogenic pulmonary edema, CPAP safely provides earlier improvement of dyspnea, respiratory distress and oxygen saturation, and regarding hospital mortality, rate of endotracheal intubation and intensive care unit (ICU) length of stay than does standard oxygen therapy.
We recommend that Continuous positive airway pressure ventilation (CPAP) should be considered as adjunctive therapy in patients with acute cardiogenic pulmonary edema who have severe respiratory distress or whose condition does not improve with pharmacologic therapy.