Continuous Positive Airway Pressure (CPAP) May Not Reduce Short-Term Mortality in Cardiogenic Pulmonary Edema: A Propensity-Based Analysis.

Feb 2013

Pirracchio R, Resche Rigon M, Mebazaa A, Zannad F, Alla F, Chevret S.

Source

Department of Biostatistics, Hôpital Saint Louis, Diderot, Paris, France; Department of Anesthesiology & Critical Care, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: romain.pirracchio@gmail.com.

Abstract

INTRODUCTION:

Continuous positive airway pressure (CPAP) improves patients' condition in case of cardiogenic pulmonaryedema (CPE). However, the impact of CPAP on short-term mortality remains a matter of debate. We aimed at estimating the effect of CPAP on short-term mortality in patients treated for a CPE.

METHODS AND RESULTS:

We pooled the data from the Acute Heart Failure Global Registry of Standard Treatment and the Etude Francaise l'Innsuficiens Cardiaque Aigue observational cohorts to compare the estimations of the effect on short-term mortality of CPAP, before and after propensity score (PS) matching. A total of 2286 patients with a cardiogenic pulmonary edema were included in the analysis, of whom 321 (14%) received CPAP. Of these, 314 could be matched to a control patient (matched population: n = 628) and were included in the PS analysis. In naive analysis, CPAP application influenced neither short-term mortality (HR: 1.03, 95% CI: 0.73-1.46; P = .86) nor the need for tracheal intubation (OR: 1.04, 95% CI: 0.78-1.40; P = .78). After PS matching, CPAP was associated with a reduction in the need for tracheal intubation but it did not reduce short-term mortality. 

CONCLUSIONS:

Despite a reduction in the need for tracheal intubation, CPAP application may not reduce short-term mortality in patients suffering from cardiogenic pulmonary edema.

PubMed

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction.

Feb 2012

Shin JH, Kim SH, Park J, Lim YH, Park HC, Choi SI, Shin J, Kim KS, Kim SG, Hong MK, Lee JU.

Source

Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea.

Abstract

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

PubMed