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Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study.
- Source :
-
International journal of cardiology [Int J Cardiol] 2017 Mar 01; Vol. 230, pp. 191-197. Date of Electronic Publication: 2016 Dec 27. - Publication Year :
- 2017
-
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.<br />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.<br />Results: Mean age was 67years, 74% were men. The MV and NIV groups did not differ in age, medical history, etiology of CS, PaO <subscript>2</subscript> /FiO <subscript>2</subscript> 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 PaO <subscript>2</subscript> were independent predictors of mortality, whereas ventilation strategy did not have any influence on outcome.<br />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.<br /> (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Aged
Europe epidemiology
Female
Hospital Mortality trends
Humans
Male
Noninvasive Ventilation methods
Respiratory Insufficiency etiology
Respiratory Insufficiency mortality
Respiratory Insufficiency therapy
Shock, Cardiogenic complications
Shock, Cardiogenic mortality
Survival Rate trends
Intensive Care Units
Respiration, Artificial methods
Shock, Cardiogenic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 230
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 28043661
- Full Text :
- https://doi.org/10.1016/j.ijcard.2016.12.175