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ACEM Spring Symposium
ACEM Spring Symposium
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Effect of Oxygen Therapy on the Risk of Mechanical Ventilation in Emergency Acute Pulmonary Edema Patients

Presentation Description

Acute cardiogenic pulmonary edema (ACPE) is a common medical emergency presenting to the Emergency Department (ED) and Oxygen is commonly given to reverse hypoxaemia.[1] However, there is growing evidence to suggest the harm of over-oxygenation in a variety of critical conditions.[2-9] So far, there is little to no evidence of the effects of hyperoxaemia in ACPE. 
We investigated the effects of hyperoxemia on morbidity and mortality in ACPE.
We conducted a retrospective cohort study of patients presenting to a tertiary hospital ED with ACPE with an arterial blood gas (ABG) performed. Patients were classified into three categories according to their partial pressures of arterial Oxygen (PaO2) on the first ED ABG: namely hypoxemic (<75 mmHg), normoxemic (75-100 mmHg) and hyperoxemic (>100 mmHg). The primary outcome was the ED rates of mechanical (invasive and noninvasive) ventilation (MV) between the groups after correction for known risk factors.[11-15] Secondary outcomes included hospital length of stay and rates of intra-hospital mortality. 
We recruited 335 patients; 34.0% had hyperoxemia. 27.5% had normoxemia and 38.5% had hypoxemia. The adjusted odds ratios (OR) for MV of the hyperoxemic and hypoxemic groups were 0.98 (95% CI: 0.53–1.79) and 1.38 (95% CI 0.77–2.48) (reference: normoxemic group). Intubation rates for the groups were: hyperoxemic 12/114 (10.6%) vs normoxemic 6/92 (6.5%) vs hypoxemic 15/129 (11.6%) (P=0.43). Secondary outcome rates were comparable between the groups.
Our study did not illustrate any statistically significant effects of hyperoxemia on our primary and secondary outcomes as compared to hypoxemia and normoxemia in ED patients with ACPE.


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