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Acute Cardiogenic Pulmonary Edema (6)

Table 3 lists patient characteristics 24 hours after the onset of mechanical ventilation. Survivors were more likely to be ventilator independent, and a higher proportion were awake and responsive. Nonsurvivors had lower blood pressure, a lower a/A ratio for oxygen, less frequently had improvement of pulmonary edema on chest roentgenogram, and were more likely to require vasoactive and antiarrhythmic medication; 93.5    percent of those requiring vasoactive medication at 24 hours had sustained a myocardial infarction.
Eleven survivors and 21 nonsurvivors (p<0.001) had pulmonary artery balloon flotation catheters. Most of these were inserted more than 12 hours after the onset of pulmonary edema. Pulmonary artery occlusion pressures were similar, 18.6 ±5.7 for survivors, and 21.0±4.0 for nonsurvivors.
Twenty patients had nuclear cardiac wall motion studies performed during their hospital admission for pulmonary edema (6.0 ±2.9 days after intubation). Fourteen patients had echocardiography, five of whom also had nuclear wall motion studies. The mean ejection fraction was 38.71 percent ±18.1 percent; 45.5    percent of the studies showed ejection fractions of 30 percent or less; 94 percent of studies showed hypokinesis of the ventricular wall.
The APACHE II score for those who died was 20.7 ±5.6 vs 24.5 ±6.7 for those who lived. No relationship between increasing APACHE II score and increasing mortality was observed.

Table 3—Clinical Characteristics 24 Hours after Onset of Mechanical Ventilation

Survivors, % n = 56 Nonsurvivors, % n = 26* P
A. Discrete variables
Vasopressors 17.9 80.8 <0.001
Lidocaine 16.1 42.3 <0.01
CXR improved 83.9 50.0 <0.001
Awake and responsive 94.6 73.1 <0.01
On ventilator 57.1 84.6 <0.005
Peak CPK >1000 U/mlt 8.9 40.6 <0.001
B. Continuous variables
Low HR* 79.6 ±14.2 88.4 ±25.8 NS
High HR* 104.0 ±20.4 126.3 ±20.8 <0.001
Low systolic BP$ 120.5 ±23.5 88.4 ±29.1 <0.001
High systolic BP$ 164.1 ±27.6 138.5 ±35.5 <0.001
Arterial pH 7.45 ±.05 7.45 ±.05 NS
Arterial Pco2 39.4 ±5.5 34.1 ±5.9 <0.001
a/A for 02 0.40 ±.15 0.30 ±.12 <0.005
hco3 27.8 ±4.4 23.2±5.1 <0.001
BUN 35.3± 17.8 40.7 ±18.7 NS
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