title: Noninvasive ventilation in patients with acute cardiogenic pulmonary edema.
abstract: Acute cardiogenic pulmonary edema (ACPE) is a common cause of respiratory failure that necessitates endotracheal intubation. In some patients intubation and its attendant complications can be avoided with noninvasive ventilation (NIV). Both continuous positive airway pressure (CPAP) and NIV have been evaluated in patients with ACPE. Compared to conventional treatment, both CPAP and NIV improve vital signs and physiologic variables, and reduce intubation rate, in patients with ACPE. Both CPAP and NIV appear to be well tolerated and are not associated with any serious adverse events. Initial concern that NIV may be associated with a greater risk of myocardial infarction than CPAP was laid to rest by later studies. Despite a physiologic rationale that NIV should offer greater benefit than CPAP, NIV has not been found to offer any advantages regarding intubation rate or mortality compared with CPAP. We review the randomized controlled trials and summarize the evidence on NIV and CPAP in patients with ACPE.
authors.affiliation: Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada. geeta.mehta@utoronto.ca
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Abdul Hakeem
authors.initials: AH
authors.lastname: Al-Hashim
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D011654:Pulmonary Edema / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012122:Ventilators, Mechanical / Q000009:adverse effects