Use of noninvasive and invasive mechanical ventilation in cardiogenic shock: A prospective multicenter study

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• 作者：Mari Hongisto^a ; ^{mari.hongisto@hus.fi} ; Johan Lassus^b ; Tuukka Tarvasmaki^a ; Alessandro Sionis^c ; Heli Tolppanen^b ; Matias Greve Lindholm^d ; Marek Banaszewski^e ; John Parissis^f ; Jindrich Spinar^g ; Jose Silva-Cardoso^h ; Valentina Carubelliⁱ ; Salvatore Di Somma^j ; Josep Masip^k ; Veli-Pekka Harjola^a
• 关键词：CS ; cardiogenic shock ; AMI ; acute myocardial infarction ; MV ; invasive mechanical ventilation ; NIV ; noninvasive ventilation ; APE ; acute cardiogenic pulmonary edema ; STEMI ; ST-elevation myocardial infarction ; ACS ; acute coronary syndrome ; ARDS ; acute respiratory distress syndrome ; eGFR ; estimated glomerular filtration rate ; LVEF ; left ventricular ejection fraction ; MI ; myocardial infarction ; CABG ; coronary artery bypass grafting ; SD ; standard deviation ; IQR ; interquartile range ; OR ; odds ratio ; CI
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：191-197
• 全文大小：336 K
• 卷排序：230

文摘

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.Methods219 CS patients were categorized by the maximum intensity of ventilatory support they needed during the first 24 h 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.ResultsMean age was 67 years, 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.ConclusionsAlthough 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.