ASSOCIATION OF ARTERIAL HYPERCAPNIA IN ACUTE HEART FAILURE PATIENT WITH EARLY NEED OF INTUBATION IN EMERGENCY DEPARTMENTA COHORT STUDY CONDUCTED AT TERTIARY CARE SETUP IN PAKISTAN

Abstract

ABSTRACT
INTRODUCTION: Acute respiratory distress is often observed in patients with acute heart
failure that is common cause of hospitality, especially in the elderly, and also has a high mortality
rate. OBJECTIVE: Acute respiratory distress is a common finding among individuals who have
acute heart failure significantly contributing to increased mortality rate. This studies aim to
examine and access the association of respiratory acidosis (PaCO2 >45 mmHg), a condition known
as arterial hypercapnia with the need of early intubation. METHODS: It is a retrospective cohort
study conducted at Dr. Ziauddin University Hospital. Data was abstracted from the online database
of the institute- software known as EMR of the patients who gave consent. After the application
of the inclusion and exclusion criteria only 88 patients out of the 15,400 clinical records initially
recorded were further sent for analysis. RESULT: Of the 88 patients, 74.8% presented with acute
diastolic heart failure (ADHF), 2.6% presented with right ventricular heart failure, 5.6 % presented
with hypertensive heart failure, 0.5% presented with left ventricular heart failure and the remaining
16.5% presented with acute pulmonary edema. 41.3% had prior hospitalization due to heart failure.
Mean age for the overall cohort is 70.2 +/- 8.0, out of which 60.6 % were male. Patients who
manifested pre-hospital hypercapnia and were not ventilated in a pre-hospital setup (n=76) were
managed mostly through early intubation (78.5 %) and those had did not have hypercapnia prior
to admission (i.e. a pre-hospital setup) only required intubation in 12.6% of the cases.
CONCLUSION: Through the study results and statistical analysis it can be concluded that there
is positive correlation between the severity of respiratory distress and need of early intubation, as
it could trigger hypoxemia if not treated hence cardiogenic shock is possible.