Is Hypocapnia Associated With Non-Invasive Ventilation Failure in Cardiogenic Acute Pulmonary Edema Patients?

The role of hypocapnia in the prognosis of cardiogenic acute pulmonary edema (CAPE) was understudied. Researchers sought to determine whether hypocapnia was a risk factor for NIV failure and hospital mortality in CAPE patients for a study. A retrospective observational study of all CAPE patients treated with NIV. Patients were divided into 3 groups based on their PaCO2 levels (hypocapnia, eucapnic, and hypercapnic). The need for endotracheal intubation and/or death was defined as NIV failure. There were 1,138 patients studied, with 390 (34.3%) having hypocapnia, 186 (16.3%) having normocapnia, and 562 (49.4%) having hypercapnia. NIV failure was more common in hypocapnia patients (60 patients, 15.4%) than in eucapnic (16 patients, 8.6%) and hypercapnic (562 patients, 10.7%), with statistical significance (P=0.027), as was hospital mortality, which was 73 (18.7%), 19 (10.2%), and 83 (14.8%) respectively (P=0.026). The presence of a do-not-intubate order, complications related to NIV, a lower left ventricular ejection fraction, a higher SAPS II and SOFA score, and a higher HACOR score at 1 hour of NIV initiation were all predicted factors for NIV failure. Hypocapnia was associated with NIV failure and increased in-hospital mortality in CAPE patients.

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