title: A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects.
abstract: OBJECTIVE
  In acute cardiogenic pulmonary oedema (ACPE), continuous positive airway pressure (CPAP) added to medical treatment improves outcome. The present study was designed to assess the benefit of CPAP as a first line treatment of ACPE in the out-of-hospital environment.
  
  
  RESULTS
  The protocol lasted 45 min, divided into three periods of 15 min. Patients with ACPE were randomly assigned in two groups: 1/Early CPAP (n = 63): CPAP alone (T0-T15); CPAP + medical treatment (T15-T30); medical treatment alone (T30-T45) and 2/Late CPAP (n = 61): medical treatment alone (T0-T15); medical treatment + CPAP (T15-T30); medical treatment alone (T30-T45). Primary endpoint: effect of early CPAP on a dyspnoea clinical score and on arterial blood gases. Secondary endpoints: incidence of tracheal intubation, inotropic support, and in-hospital mortality. T0-T15: CPAP alone had a greater effect than medical treatment on the clinical score (P = 0.0003) and on PaO(2) (P = 0.0003). T15-T30: adding CPAP to medical treatment (late CPAP group) improved clinical score and blood gases and the two groups were no longer different at T30. T30-T45: in both groups, CPAP withdrawal worsened clinical score. Six patients in 'early CPAP' group vs. 16 in 'late CPAP' group were intubated [P = 0.01, odds-ratio: OR = 0.30 (0.09-0.89)]. Dobutamine was used only in the 'late CPAP' group (n = 5), (P = 0.02). Hospital death was higher in 'late CPAP' group (n = 8) than in 'early CPAP' group (n = 2) [P = 0.05, OR = 0.22 (0.04-1.0)].
  
  
  CONCLUSIONS
  When compared to usual medical care, immediate application of CPAP alone in out-of-hospital treatment of ACPO is significantly better improving physiological variables and symptoms and significantly reduces tracheal intubation incidence and in-hospital mortality.
authors.affiliation: Department of Anaesthesiology and Critical Care, Lariboisière University Hospital AP-HP, 2 Rue Ambroise Paré, Paris 75010, France.
authors.forename: P
authors.initials: P
authors.lastname: Plaisance
authors.forename: R
authors.initials: R
authors.lastname: Pirracchio
authors.forename: Christine
authors.initials: C
authors.lastname: Berton
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: D
authors.initials: D
authors.lastname: Payen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*