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Acute Cardiogenic Pulmonary Edema (5)

Acute Cardiogenic Pulmonary Edema (5)Results
The mean age of survivors and non-survivors was 72.9 ±9.3 years and 73.8 ±10.1 years, respectively; 48.2 percent of survivors and 62.5 percent of nonsurvivors were men (p<0.05).
Table 1 shows medical history and medication use. More survivors had been hospitalized before for treatment of pulmonary edema, and more survivors had a history of congestive heart failure. The prevalence of ischemic heart disease w as the same in both groups. Nonsurvivors more frequently used calcium channel blocker medication, and there was a tendency for more frequent use of p-blocker medication among nonsurvivors (p = 0.15).
Table 2 lists patient characteristics at the onset of mechanical ventilation. Nonsurvivors had a twofold increase in the incidence of myocardial infarction compared with survivors and a threefold increase in the frequency of anterior infarction. Nonsurvivors had a lower systolic blood pressure, respiratory rate, PaC02, and serum bicarbonate level, and a higher pH than did survivors.
By analysis of receiver operator characteristic curves, a blood pressure of 130 mm Hg had the best balance of sensitivity (84.4 percent) and specificity (82.1 percent) for mortality. Figure 1 shows that patients with myocardial infarction (open circles) had a lower initial systolic pressure than those patients without myocardial infarction, 128.8 ±48.8 mm Hg compared with 167.4 ±36.8 mm Hg (p<0.001).

Table 1—Medical History and Medication Use

Survivors, % n = 56 Nonsurvivors, % n = 32 P
Previous hospitalization for pulmonary edema 35.7 12.5 <0.025
Congestive heart failure 57.1 31.3 <0.025
Hypertension 58.9 43.8 NS
Angina 42.9 40.6 NS
Myocardial infarction 51.8 46.9 NS
Diabetes 41.1 15.6 <0.025
Cardiovascular disease 39.3 15.6 <0.025
p-blocker 17.9 31.3 NS
Ca+ * channel blocker 23.2 43.8 <0.05
Digoxin 53.6 50.0 NS
Diuretic 70.8 29.2 <0.001

Table 2—Clinical Characteristics at Onset of Mechanical Ventilation

Survivors, % n = 56 Nonsurvivors, % n = 32 P
A. Discrete variables
MI at onset 42.8 84.4 <0.001
Anterior MI 19.6 59.4 <0.001
Inferior MI 19.6 12.5 NS
Cardiomegaly on CXR 51.8 43.8 NS
Pleural effusion on CXR 23.2 25.0 NS
Peripheral edema 46.4 18.7 <0.01
Nonconscious 37.5 34.4 NS
Rales 91.1 87.5 NS
Cutaneous vasoconstriction 76.8 78.1 NS
B. Continuous variables
Heart rate 109.7 ±27.4 109.2 ±25.7 NS
Respiratory rate 35.1 ±7.7 28.7 ±6.4 <0.001
Systolic blood pressure 166.1 ±41.9 108.2 ±.33.9 <0.001
Arterial pH 7.17 ±.14 7.27 ±.15 <0.005
Arterial Pco2 65.6 ±20.7 46.7 ±16.5 <0.001
a/A ratio for oxygen 0.29 ±.16 0.27 ±.17 NS
HCO, 23.2±4.7 20.2 ±4.6 <0.005
BUN 29.3 ±13.7 30.6 ±13.6 NS
HCT 41.1 ±6.9 38.8±5.8 NS

Figure-1
Figure 1. Systolic blood pressure at time of intubation for nonsurvivors and survivors. Open circles represent episodes associated with an acute myocardial infarction.

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