Pulmonary acute edema: analysis of morbid-mortality in the ICU

Introduction

In order to analyze morbidity and mortality associated with pulmonary acute edema, a protocol was established with a prospective data collection.

Materials and methods

From October 2003 to October 2004, 2012 patients were admitted to the ICU of Santa Lucia Hospital and 705 (35%) to the cardiologic ICU. All patients were analyzed prospectively and 39 patients had pulmonary acute edema as the primary cause of admission.

Results

Thirty-nine patients had pulmonary acute edema. The mean age was 72.9 years old, 21 were women and 18 were men. Thirty-one (88.6%) out of this group had a history of high blood pressure and 24 (61.5%) related previous admissions by cardiac diseases. Thirteen (34.2%) patients were admitted with systolic blood pressure (SBP) ≥ 200 mmHg and 11 (28.4%) had SBP between 160 and 199 mmHg. Thirteen patients used sodium nitroprusside. The most frequent symptoms were respiratory insufficiency, observed in 79.5%, and tachyarrhythmia (56.4%). Seventeen (43.6%) patients needed intubation and mechanical ventilation. Four were submitted to non-invasive mechanical ventilation (NIMV) and 15 patients needed vasoactive drugs. The mean ICU stay was 9.4 days. The mortality rate was 28.2%.

Conclusion

The high mortality associated with the high number of patients that needed tracheal intubation and ventilatory prothesis shows the severity of disease. NIMV becomes an important therapeutic option to avoid intubation in selected patients.