• Luna Carrillo-Aleman, Elena Carrasco-Gónzalez, Maria João Araújo, Miguel Guia, Nuria Alonso-Fernández, Ana Renedo-Villarroya, Laura López-Gómez, Aurea Higon-Cañigral, Juan M Sanchez-Nieto, and Andrés Carrillo-Alcaraz.
• Intensive Care Unit, Hospital Morales Meseguer; Av Marqués de los Vélez, s/n, 30008 Murcia, Spain.
• J Crit Care. 2022 Jun 1; 69: 153991.

Introduction And PurposeThe impact of hypocapnia in the prognosis of cardiogenic acute pulmonary edema (CAPE) has not been sufficiently studied. The aim of this study was to analyse whether hypocapnia is a risk factor for non-invasive ventilation (NIV) failure and hospital mortality, in CAPE patients CAPE.MethodsRetrospective observational study of all patients with CAPE treated with NIV. Patients were classified in three groups according to PaCO2 level (hypocapnic, eucapnic and hypercapnic). NIV failure was defined as the need for endotracheal intubation and/or death.Results1138 patients were analysed, 390 (34.3%) of which had hypocapnia, 186 (16.3%) had normocapnia and 562 (49.4%) had hypercapnia. NIV failure was more frequent in hypocapnic (60 patients, 15.4%) than in eucapnic (16 pacientes, 8.6%) and hypercapnic group (562 pacientes, 10.7%), with statistical significance (p = 0.027), as well as hospital mortality, 73 (18.7%), 19(10.2%) and 83 (14.8%) respectively (p = 0.026). The predicted factors for NIV failure were the presence of do-not-intubate order, complications related to NIV, a lower left ventricular ejection fraction, higher SAPS II and SOFA score and a higher HACOR score at one hour of NIV initiation.ConclusionsHypocapnia in patients with CAPE is associated with NIV failure and a greater in-hospital mortality.Copyright © 2022 Elsevier Inc. All rights reserved.

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