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Yukino M, Nagatomo Y, Goda A, Kohno T, Takei M, Nishihata Y, Saji M, Toyosaki Y, Nakano S, Ikegami Y, Shiraishi Y, Kohsaka S, Adachi T, Yoshikawa T. Association of Non-Invasive Positive Pressure Ventilation with Short-Term Clinical Outcomes in Patients Hospitalized for Acute Decompensated Heart Failure. J Clin Med 2021; 10:jcm10215092. [PMID: 34768609 PMCID: PMC8584464 DOI: 10.3390/jcm10215092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/06/2023] Open
Abstract
The real-world evidence has been sparse on the impact of non-invasive positive pressure ventilation (NPPV) on the outcomes in acute decompensated heart failure (ADHF) patients. We aim to explore this issue in the prospective multicenter WET-HF registry. Among 3927 patients (77 (67–84) years, male 60%), the NPPV was used in 775 patients (19.7%). The association of NPPV use with in-hospital outcome and length of hospital stay (LOS) was examined by two methods, propensity score (PS) matching and multivariable analysis with adjustment for PS. In these analyses the NPPV group exhibited a lower endotracheal intubation (ETI) rate and a comparable in-hospital mortality, but longer LOS compared to the non-NPPV group. In the stratified analysis, the NPPV group exhibited a significantly lower ETI rate in patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg and the Controlling Nutritional Status (CONUT) score ≤ 3, indicating better nutritional status. On the contrary, NPPV use was associated with longer LOS in patients with non-ischemic etiology, sBP < 100 mmHg and CONUT score > 3. In conclusion, NPPV use was associated with a lower incidence of ETI. Particularly, patients with ischemic etiology, high sBP, and better nutritional status might benefit from NPPV use.
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Affiliation(s)
- Midori Yukino
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
- Correspondence: ; Tel.: +81-4-2995-1597
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo 108-0073, Japan;
| | - Yosuke Nishihata
- Department of Cardiology, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (M.S.); (T.Y.)
| | - Yuichi Toyosaki
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (Y.T.); (S.N.)
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (Y.T.); (S.N.)
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
- Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo 160-8582, Japan; (Y.S.); (S.K.)
| | - Shun Kohsaka
- Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo 160-8582, Japan; (Y.S.); (S.K.)
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (M.S.); (T.Y.)
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Abubacker AP, Ndakotsu A, Chawla HV, Iqbal A, Grewal A, Myneni R, Vivekanandan G, Khan S. Non-invasive Positive Pressure Ventilation for Acute Cardiogenic Pulmonary Edema and Chronic Obstructive Pulmonary Disease in Prehospital and Emergency Settings. Cureus 2021; 13:e15624. [PMID: 34277241 PMCID: PMC8277092 DOI: 10.7759/cureus.15624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Non-invasive ventilation is an important intervention in treating acute respiratory failure caused by acute cardiogenic pulmonary edema (ACPE) and acute exacerbations of chronic obstructive pulmonary disease (COPD). Although there are studies that give evidence on the efficacy and safety of non-invasive ventilation over standard medical care for COPD and cardiogenic pulmonary edema, less are known about the form of non-invasive ventilation, continuous positive airway pressure (CPAP), or bilevel positive airway pressure (BiPAP) as an effective intervention for respiratory failure and its efficacy and safety in prehospital settings. We conducted a systematic review by using PubMed and Google Scholar as databases for collecting studies related to the effectiveness of CPAP and BiPAP for cardiogenic pulmonary edema and COPD; the major outcome studied was reducing rates of endotracheal intubation secondary and tertiary outcomes included mortality reduction and shortening length of hospital stay. The study follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist 2009. Sixteen studies were identified, including systematic reviews, randomized control trials, and observational studies. Studies published on or after 2010 in a population greater than 40 years old suffering from acute COPD and cardiogenic pulmonary edema were taken for review. Studies that described other respiratory diseases treated with non-invasive ventilation were excluded. Quality appraisal was done using the Cochrane risk bias tool for randomized control trials, Amstar-2 for systematic reviews, and New Castle Ottawa Tool for observational studies. Five studies compared the effectiveness of CPAP and BiPAP with standard medical care in prehospital and emergency settings. Six studies described prehospital intervention. Both forms of non-invasive ventilation were equally significant and effective. Prehospital use had tremendously reduced intubation rates, with not much variability noticed for mortality and hospital stay. Non-invasive ventilation is an effective measure for respiratory failure secondary to COPD and ACPE. Early out of hospital utilization of CPAP and BiPAP reduces the rate of invasive ventilation and reduces complications due to endotracheal intubation. Endotracheal intubation is associated with a considerable incidence of complications like failed intubation, hypotension, or circulatory arrest, even if the emergency physician is well trained, making these forms of non-invasive ventilation safe and effective interventions in the prehospital settings.
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Affiliation(s)
- Ansha P Abubacker
- Emergency Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Andrew Ndakotsu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Harsh V Chawla
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aimen Iqbal
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amit Grewal
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Revathi Myneni
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Govinathan Vivekanandan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Khayat RN, Javaheri S, Porter K, Sow A, Holt R, Randerath W, Abraham WT, Jarjoura D. In-Hospital Management of Sleep Apnea During Heart Failure Hospitalization: A Randomized Controlled Trial. J Card Fail 2020; 26:705-712. [PMID: 32592897 DOI: 10.1016/j.cardfail.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased mortality and readmissions in patients with heart failure (HF). The effect of in-hospital diagnosis and treatment of OSA during decompensated HF episodes remains unknown. METHODS AND RESULTS A single-site, randomized, controlled trial of hospitalized patients with decompensated HF (n = 150) who were diagnosed with OSA during the hospitalization was undertaken. All participants received guideline-directed therapy for HF decompensation. Participants were randomized to an intervention arm which received positive airway pressure (PAP) therapy during the hospitalization (n = 75) and a control arm (n = 75). The primary outcome was discharge left ventricular ejection fraction (LVEF). The LVEF changed in the PAP arm from 25.5 ± 10.4 at baseline to 27.3 ± 11.9 at discharge. In the control group, LVEF was 27.3 ± 11.7 at baseline and 28.8 ± 10.5 at conclusion. There was no significant effect on LVEF of in-hospital PAP compared with controls (P = .84) in the intention-to-treat analysis. The on-treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP for ≥3 hours per night (n = 36, 48%) compared with those who used it less (P = .01). There was a dose effect with higher hours of use associated with more improvement in LVEF. Follow-up of readmissions at 6 months after discharge revealed a >60% decrease in readmissions for patients who used PAP ≥3 h/night compared with those who used it <3 h/night (P < .02) and compared with controls (P < .04). CONCLUSIONS In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. An exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions.
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Affiliation(s)
- Rami N Khayat
- The UCI Sleep Disorders Center and the Division of Pulmonary and Critical Care, University of California at Irvine, Irvine, California; The Sleep Heart Program at the Ohio State University, Columbus, Ohio.
| | - Shahrokh Javaheri
- Bethesda North Hospital, Cincinnati, Ohio; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kyle Porter
- The Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Angela Sow
- The Sleep Heart Program at the Ohio State University, Columbus, Ohio; The Center for Clinical and Translational Science, The Ohio State University Columbus, Ohio
| | - Roger Holt
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Winfried Randerath
- Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - David Jarjoura
- The Sleep Heart Program at the Ohio State University, Columbus, Ohio; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio; The Center for Biostatistics, The Ohio State University, Columbus, Ohio
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Hongisto M, Lassus J, Tarvasmaki T, Sionis A, Tolppanen H, Lindholm MG, Banaszewski M, Parissis J, Spinar J, Silva-Cardoso J, Carubelli V, Di Somma S, Masip J, Harjola VP. Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study. Int J Cardiol 2016; 230:191-197. [PMID: 28043661 DOI: 10.1016/j.ijcard.2016.12.175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/22/2016] [Accepted: 12/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite scarce data, invasive mechanical ventilation (MV) is widely recommended over non-invasive ventilation (NIV) for ventilatory support in cardiogenic shock (CS). We assessed the real-life use of different ventilation strategies in CS and their influence on outcome focusing on the use of NIV and MV. METHODS 219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24h into MV (n=137; 63%) , NIV (n=26; 12%), and supplementary oxygen (n=56; 26%) groups. We compared the clinical characteristics and 90-day outcome between the MV and the NIV groups. RESULTS Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO2/FiO2 ratio, baseline hemodynamics or LVEF. MV patients predominantly presented with hypoperfusion, with more severe metabolic acidosis, higher lactate levels and greater need for vasoactive drugs, whereas NIV patients tended to be more often congestive. 90-day outcome was significantly worse in the MV group (50% vs. 27%), but after propensity score adjustment, mortality was equal in both groups. Confusion, prior CABG, ACS etiology, higher lactate level, and lower baseline PaO2 were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome. CONCLUSIONS Although MV is generally recommended mode of ventilatory support in CS, a fair number of patients were successfully treated with NIV. Moreover, ventilation strategy was not associated with outcome. Thus, NIV seems a safe option for properly chosen CS patients.
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Affiliation(s)
- Mari Hongisto
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland.
| | - Johan Lassus
- Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland
| | - Tuukka Tarvasmaki
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona, Spain
| | - Heli Tolppanen
- Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland
| | - Matias Greve Lindholm
- Rigshospitalet, Copenhagen University Hospital, Intensive Cardiac Care Unit, Copenhagen, Denmark
| | - Marek Banaszewski
- Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
| | - John Parissis
- Attikon University Hospital, Heart Failure Clinic and Secondary Cardiology Department, Athens, Greece
| | - Jindrich Spinar
- University Hospital Brno, Department of Internal Medicine and Cardiology, Brno, Czech Republic
| | - Jose Silva-Cardoso
- University of Porto, CINTESIS, Department of Cardiology, Porto Medical School, São João Hospital Center, Porto, Portugal
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy
| | - Salvatore Di Somma
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital, Rome, Italy
| | - Josep Masip
- University of Barcelona, Hospital Sant Joan Despi Moisès Broggi, Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland
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Koraćević G, Stojković A, Janković-Tomašević R, Dimitrijević E, Petrović S, Pavlović M, Damjanović M, Kostić T, Kutlešić M, Sokolović M, Stojanović M. SYSTOLIC BLOOD PRESSURE IS A VALID MARKER OF IN-HOSPITAL SURVIVAL IN ACUTE CARDIOGENIC PULMONARY EDEMA - ANALYSIS OF 1.397 PATIENTS. ACTA MEDICA MEDIANAE 2015. [DOI: 10.5633/amm.2015.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Esquinas AM, Bellone A. CPAP and Short-Term Mortality in Acute Cardiac Pulmonary Edema: Now, What Can We Be Expecting? J Card Fail 2013; 19:722. [DOI: 10.1016/j.cardfail.2013.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Indexed: 11/26/2022]
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Pirracchio R, Mebazaa A. Reply to short-term mortality and CPAP in acute cardiac pulmonary edema: how and what can we be expecting? J Card Fail 2013; 19:723-4. [PMID: 24125111 DOI: 10.1016/j.cardfail.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Romain Pirracchio
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France; Department of Biostatistics, INSERM UMR-S717, Hôpital Saint Louis, Paris, France.
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