Aim. To determine the need for pressure controlled non-invasive mechanical ventilation for reperfusion myocardial injury prevention in patients with ST-elevation myocardial infarction (STEMI). Methods. The study enrolled 61 patients admitted to the intensive care unit within 6 hours from the debut of chest pain, ST-segment elevation on electrocardiogram and oxygen saturation less than 90%. A percutaneous coronary intervention on an affected coronary artery was performed in all patients 30-90 minutes from admission. Non-invasive mechanical ventilation using the «MAQUET Servo-s» machine was started in patients of the first group (31 patients, mean age 66.3±10.7 years, males - 19, females - 12) with positive end expiratory pressure of 2-6 cm H2O, pressure support of 6-10 cm H2O, 40-60% O2 gas mix. Patients of the second group (comparison group, 30 patients, mean age 63.5±9.8 years, males - 16, females - 14) were offered a conventional treatment of ST-elevation myocardial infarction, including inhalations of humidified oxygen (6-8 liters per minute) using a nasal cannula. Results. Systolic, diastolic blood pressure and heart rate were 123.0±9.4 mm Hg, 81.2±11.3 mm Hg, 70.1±6.1 beats per minute in patients of the first group in 6 hours after admission. In patients of the comparison group the following parameters were measured as 157±12.4 mm Hg, 90.2±10.1 mm Hg, 92.6±10.2 beats per minute. The absolute risk increase of arrhythmias related to reperfusion myocardial injury was 17.8% (р 0.05) for the patients from the second group. Ejection fraction on a transthoracic echocardiogram (Teichholz method) was measured as 47.0±4.0 and 60.5±7.4% in patients from the first and the second groups respectively (р 0.05). Conclusion. Non-invasive mechanical ventilation decreases the risk for arrhythmias related to reperfusion myocardial injury, and increases the ejection fraction compared to conventional treatment and can be applied in patients with STEMI.
Mechanical ventilation in the early phase of ST elevation myocardial infarction treated with mechanical revascularization