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Acute Cardiogenic Pulmonary Edema (10)

For example, Goldberger et al did not mention the number of patients treated with mechanical ventilation in their study of 106 hospital admissions; Plotnick et al reported that 26 of 55 patients received “IPPB,” and 15 of 44 patients received mechanical ventilation in the study of Weiner et al. Plotnick et al” excluded patients with cardiogenic shock. Only 29.0 percent of patients had myocardial infarction and none had systolic blood pressure less than 100 mm Hg in the study of Goldberger et al, compared with 57.2 percent and 23.8 percent, respectively, in ours. These comparisons indicate that the patients in our series were more severely ill, likely accounting for the higher mortality rate. Our death rate was not elevated by mortality due to comorbid illness or noncardiac complications, since 31 of 32 deaths were cardiac in etiology. Our one-year mortality of 33 percent of those discharged is similar to the 34 percent and 43 percent reported by Goldberger et al and Plotnick et al,n respectively, and our two-year mortality of 50 percent is similar to the 40 percent reported by Weiner et al.

We found no relationship between mortality and APACHE II scores (a severity of illness scale), and have reported the details of this finding elsewhere. One explanation may be that critically ill patients with pulmonary edema acquire APACHE II points for tachycardia, tachypnea, acidosis, hypoxemia, and mental status alterations, all of which may be quickly reversible with treatment, including mechanical ventilation.

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