SPONTANEOUS POSITIVE END-EXPIRATORY PRESS URE VENTILATION IN ELDERLY PATIENTS WITH CARDIOGENIC PULMONARY-EDEMA - ASSESSMENT IN AN EMERGENCYADMISSIONS UNIT

OBJECTIVES: Intubation and ventilatory assistance are often required I n patients presenting severe hypoxemic respiratory distress, but may b e contraindicated in elderly subjects due to an undelying condition.Th e aim oi this study was to assess the feasibility, acceptability and c ontribution of early assistance with spontaneous positive end-expirato ry pressure ventilation for elderly subjects admitted to an emergency unit for acute respiratory distress due to cardiogenic pulmonary edema . PATIENTS AND METHODS: In our emergency admission unit, ail patients with life-threatening hypoxemic respiratory distress are initially ass isted with noninvasive spontaneous positive end-expiratory pressure ve ntilation using a standardized commercial device. We retrospectively a nalyzed the files oi all patients aged over 70 years who were treated with this standard protocol for cardiogenic pulmonary edema from April 1996 through September 1997 RESULTS: During the study period, 36 pati ents aged over 70 years required ventilatory assistance according to t he standard protocol. Intubation was not reasonable in most of the pat ients (n = 30). After 1 hour of ventilation, none of the patients deve loped clinical signs of life-threatening distress. Blood gases demonst rated improved oxygenation (AE PO2 = +184.9 +/- 105.4 mmHg; p < 0.0000 01) and normalized alveolar ventilation (AE PCO2 = -10.8 +/- 15.1 mmHg ; p < 0.000001). Thirty-two patients were considered to be cured (88.9 %) and were discharged; the cardiovascular condition was fatal in 4 pa tients (11.1%). CONCLUSION: The rapid improvement in clinical signs an d blood gases as well as the final outcome suggests that early assista nce with spontaneous positive end-expiratory pressure ventilation is w arranted at admission for elderly patients with respiratory distress d ue to cardiogenic pulmonary edema. Compared with a control group of ho spitalized patients cared for during the preceding year and who were n ot treated with the standard protocol, we also demonstrated a clear im provement in mortality (11% versus 20%). (C) 1998, Masson, Paris.