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

Category: Pulmonary disease

Tags: mechanical ventilation, myocardial infarction, pulmonary edema, systolic blood pressure