P4665Noninvasive ventilation in treatment of acute pulmonary oedema due to acute coronary syndrome; propensity score matched analysis

Abstract

Introduction: Noninvasive ventilation (NIV) has shown to be effective in treatment of acute cardiogenic pulmonary oedema (ACPO), avoiding endotracheal intubation. However, its use in patients with acute coronary syndrome (ACS) is controversial. Purpose: To analyze the evolution of patients with acute pulmonary oedema caused by ACS comparing them with those caused by other etiologies. Method: Observational and prospective study of a cohort of patients admitted to Coronary Unit (CU), from 1997 to 2017, with acute respiratory failure due to ACPO. NIV was started if the patient had severe dyspnea, respiratory rate >30 breaths-1, PaO2 / FiO2 <250 or pH <7.35. NIV failure is defined as need for endotracheal intubation or death in CU. We created propensity score-matched pairs (to 1: 1 match). Matching was performed using the following variables: age, gender, SAPS II severity index and maximum SOFA in the first 24 hours, history of chronic obstructive pulmonary disease (COPD) and order of no intubation. Results:We recruited 1,318 patients with 1,350 episodes of ACPO. After propensity score-matched analysis, we compare 548 patients with ACS and 548 with other diagnoses. The comparison between variables between both groups is shown in table 1. Patients with ACS present a RR of 1.79 (95% CI: 1.41 to 2.28) for failure of NIV, and 1.51 (95% CI: 1.21 to 1.88) for hospital mortality. Conclusions: Patients with acute pulmonary oedema secondary to ACS present worse evolution and prognosis than those secondary to other causes.