title: Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema.
abstract: BACKGROUND
  Non-invasive positive pressure ventilation (NPPV) has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing.
  
  
  OBJECTIVE
  To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary edema.
  
  
  METHODS
  We undertook a comprehensive search of the following databases in April 2005: CENTRAL, MEDLINE, EMBASE, CINAHL, DARE and LILACS. We also reviewed reference lists of included studies and contacted experts, equipment manufacturers, and the Cochrane Heart Group. We did not apply language restrictions.
  
  
  METHODS
  We selected blinded or unblinded randomized or quasi-randomized clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and where NPPV (continuous positive airway pressure (CPAP)) and/or bilevel NPPV plus standard medical care was compared with standard medical care alone.
  
  
  METHODS
  Two authors independently selected articles and abstracted data using a standardized data collection form. We evaluated study quality with emphasis on allocation concealment, adherence to the intention-to-treat principle and losses to follow-up.
  
  
  RESULTS
  We included 21 studies involving 1,071 participants. Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83) with numbers needed to treat of 13 and 8, respectively. We found no difference in hospital length of stay with NPPV, however, intensive care unit stay was reduced by 1 day (WMD -1.07 days, 95% CI -1.60 to -0.53). Compared to standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.82, 95% CI 0.09 to 7.54) its application.
  
  
  CONCLUSIONS
  NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.
authors.affiliation: Muriaé Cancer Hospital , AV. Cristiano Ferreira Varella, 555, Muriaé, MG, Brazil.
authors.forename: Flávia M R
authors.initials: FM
authors.lastname: Vital
authors.forename: Humberto
authors.initials: H
authors.lastname: Saconato
authors.forename: Magdaline T
authors.initials: MT
authors.lastname: Ladeira
authors.forename: Ayan
authors.initials: A
authors.lastname: Sen
authors.forename: Claire A
authors.initials: CA
authors.lastname: Hawkes
authors.forename: Bernardo
authors.initials: B
authors.lastname: Soares
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.forename: Alvaro N
authors.initials: AN
authors.lastname: Atallah
mesh_terms: D045422:Continuous Positive Airway Pressure; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic