Effect of ED management on ICU use in acute pulmonary edema

Acute pulmonary edema (APE) is a common Emergency Department (ED) presentat ion requiring admission to an intensive care unit (ICU), This study was und ertaken to examine the effect of ED management on the need for ICU admissio n in patients with APE. ED records of APE patients were abstracted for pati ent age, prehospital and ED pharmacological treatment, diagnoses, airway in terventions, and ICU length of stay (LOS). Statistical analysis was through multiple regression, logistic regression, chi-square, and ANOVA, One hundr ed eighty one patients composed the study group, Pharmacological treatment included nitroglycerin (NTG), 147 patients (81%); morphine sulfate (MS), 88 (49%); loop diuretics (LD), 133 (73%); and captopril sublingual (CSL), 47 (26%), Use of CSL and MS were associated with opposing needs for ICU admiss ion, MS use was associated with increased ICU admissions (odds ratio, 3.08; P = .002), whereas CSL use was associated with decreased ICU admissions (o dds ratio, 0.29; P = .002), Morphine sulfate use also demonstrated an in cr eased need for endotracheal intubation (ETI) (odds ratio, 5.04; P = .001), whereas CSL demonstrated a decreased need for ETI (odds ratio, 0.16; P = .0 08). Ninety-three patients required some form of respiratory support. Forty received noninvasive pressure support ventilation (NPSV) from a bilevel po sitive airway pressure system (BiPAP), and 60 received endotracheal intubat ion. Some patients received more than 1 form of respiratory support; all ot her patients received supplemental oxygen only, The ICU-LOS associated with different airway interventions were supplemental oxygen, 0.72 days; BiPAP, 1.48 days; and ETI, 3.70 days (P < .001), Specific ED pharmacological inte rventions are associated with a decreased need for ICU admission and endotr acheal intubation in acute pulmonary edema patients, whereas use of noninva sive pressure support ventilation correlates with a reduction in the ICU le ngth of stay for patients who do require critical care admission, (C) 1999 by W.B. Saunders Company.