Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema.
OBJECTIVE
To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.


METHODS
Randomized, controlled trial.


METHODS
Tertiary hospital emergency room.


METHODS
We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.


METHODS
Oxygen applied by face mask, CPAP, and bilevel-PAP.


RESULTS
The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the PaO2/FiO2 ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).


CONCLUSIONS
Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.
Park
Marcelo
M
Division of Emergency Medicine), Heart Institute (InCor), Hospital das Clínicas, University of São Paulo, Brazil. mpark@uol.com.br
Sangean
Marcia C
MC
Volpe
Marcia de S
Mde S
Feltrim
Maria I Z
MI
Nozawa
Emilia
E
Leite
Paulo F
PF
Passos Amato
Marcelo B
MB
Lorenzi-Filho
Geraldo
G
D018806:APACHE; D000208:Acute Disease; D001784:Blood Gas Analysis; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003422:Critical Care / Q000379:methods; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000627:therapeutic use*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D018570:Risk Assessment; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D010100:Oxygen