Does continuous positive airway pressure by face mask improve patients with acute cardiogenic pulmonary edema due to left ventricular diastolic dysfunction?
Does continuous positive airway pressure by face mask improve patients with acute cardiogenic pulmonary edema due to left ventricular diastolic dysfunction?
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DOI：
10.1378/chest.127.3.1053
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发表时间：
2005-03-01
期刊：
影响因子：
9.6
通讯作者：
Romand, JA
中科院分区：
文献类型：
--
作者：
Bendjelid, K;Schütz, N;Romand, JA
目的：面罩持续气道正压通气（CPAP）是治疗重症心源性肺水肿（CPE）的有效方法。然而，据我们所知，没有研究提供了一个精确的评估CPAP对心脏功能的影响，在病人提出的CPE和保留左室（LV）functions.Design：前瞻性观察临床研究。设置：一个14床，在一所大学医院的医疗ICU。患者：9个连续的病人提出低氧急性CPE。干预措施：所有患者均选择使用10 cm H2O通过面罩进行CPAP 30 min，调整吸入氧分数以使皮肤饱和度> 90%。在CPAP应用前和CPAP呼吸最后10 min进行多普勒心电图检查。双尾配对t检验用于比较在基线（仅氧气）和CPAP后记录的数据。测量和结果：4名患者呈现CPE，左心室（LV）功能保留（在没有主动脉瓣狭窄或肥厚性心肌病的情况下，LV射血分数[LVEF] > 45%和/或主动脉速度时间积分> 17 cm）。所有患者的氧合和呼吸参数均得到改善。血流动力学监测和多普勒超声心动图分析表明，在左室收缩功能保留的患者中，CPAP治疗后平均动脉压和左室舒张末期容积显著降低（p < 0.04）。结论：CPAP可明显改善各种CPE患者的氧合和舒张功能。在LV收缩力保留的患者中，CPAP的血流动力学获益来自LV舒张末期容积（前负荷）的降低。
Objective: Continuous positive airway pressure (CPAP) by face mask is an effective method of treating severe cardiogenic pulmonary edema (CPE). However, to our knowledge, no study has provided a precise evaluation of the effects of CPAP on cardiac function in patients presenting with CPE and preserved left ventiricular (LV) function.Design: Prospective observational clinical study.Setting: A 14-bed, medical ICU at a university hospital.Patients: Nine consecutive patients presenting with hypoxemic acute CPE.Interventions: All patients were selected for 30 min of CPAP with 10 cm H2O by mask with fraction of inspired oxygen adjusted for a cutaneous saturation > 90%. Doppler ecbocardiograpby was performed before CPAP application and during the last 10 min of breathing with CPAP. Two-tailed, paired t-tests were used to compare data recorded at baseline (oxygen alone) and after CPAP.Measurements and results: Four patients presented CPE with preserved left ventricular (LV) function (a preserved LV ejection fraction [LVEF] > 45%, and/or aortic velocity time integral > 17 cm in the absence of aortic stenosis or hypertrophic cardiomyopathy). Oxygenation and ventilatory parameters were improved by CPAP in all patients. Hemodynamic monitoring and Doppler echocardiographic analysis demonstrated that in patients with preserved LV systolic function, mean arterial pressure and LV end-diastolic volume were decreased significantly by CPAP (p < 0.04). In patients with LV systolic dysfunction, CPAP improved LVEF (p < 0.05) and decreased LV end-diastolic volume (p = 0.001) significantly.Conclusion: CPAP improves oxygenation and ventilatory parameters in all kinds of CPE. In patients with preserved LV contractility, the hemodynamic benefit of CPAP results from a decrease in LV end-diastolic volume (preload).