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Panminerva Medica 2017 December;59(4):290-6

DOI: 10.23736/S0031-0808.17.03370-5


lingua: Inglese

High peak PaO2 values associated with adverse outcome in patients treated with noninvasive ventilation for acute cardiogenic pulmonary edema and pneumonia

Christiana SCHERNTHANER 1, Bernhard WERNLY 1, Michael LICHTENAUER 1, Marcus FRANZ 2, Alexander LAUTEN 3, 4, Paul C. SCHULZE 2, Bjoern KABISCH 2, Kristina BRAUN 5, Johanna MUESSIG 5, Maryna MASYUK 5, Uta C. HOPPE 1, Malte KELM 5, Christian JUNG 5

1 Department of Cardiology, Paracelsus Medical University, Salzburg, Austria; 2 Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany; 3 Department of Cardiology, Charite University Berlin, Berlin, Germany; 4 German Center for Cardiovascular Resarch (DZHK), Berlin, Germany; 5 Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany

BACKGROUND: Noninvasive ventilation (NIV) has a sigificant impact on mortality in acute respiratory failure (ARF). Predictive parameters for mortality are of high interest.
METHODS: We retrospectively analyzed 3759 blood gas analysis and clinical parameters of 475 patients presenting with ARF based on acute cardiogenic pulmonary edema and/or pneumonia. The influence of peak arterial oxygen partial pressure levels (PaO2) with respect to its predictive value for in-hopital and long-term mortality was investigated.
RESULTS: Overall intra-hospital mortality was 24%. Peak PaO2 levels in kPa were significantly higher in non-survivors (20.01±10.11) compared to survivors (15.65±6.79, P<0.001). A univariate Cox proportional-hazards analysis for long-term mortality revealed associations with maximum PaO2 levels (overall cohort: HR= 1.02; 95% CI: 1.007-1.03; P=0.003; CPE: HR= 1.02; 95% CI: 0.99-1.04, P=0.05, pneumonia: HR= 1.02; 95% CI: 1-1.4, P=0.02). A PaO2 cut-off value of 13 kiloPascal (kPa) was calculated by means of Youden Index and remained true even after correction for APACHE 2 Score (HR= 1.50; 95% CI: 1.00-2.25; P=0.05) and for PaCO2 (HR= 1.63; 95% CI: 1.14-2.33; P=0.01).
CONCLUSIONS: Peak PaO2 levels were associated with worse in-hopital and long-term mortality in patients treated with NIV due to ARF. These findings may indicate that application of high oxygen may be detrimental in such patients.

KEY WORDS: Respiratory insufficiency - Pneumonia - Pulmonary edema - Noninvasive ventilation

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