Continuous positive airway pressure vs. pressure support ventilation in acute cardiogenic pulmonary edema: a randomized trial.
BACKGROUND
Both non-invasive continuous positive airway pressure (nCPAP) and non-invasive pressure support ventilation (nPSV) have been shown to be effective treatment for acute cardiogenic pulmonary edema (ACPE). In patients with severe ACPE who are treated with standard medical treatment, the baseline intubation rate is approximately 24%.


OBJECTIVE
This study was conducted to compare the endotracheal intubation (ETI) rate using two techniques, nCPAP vs. nPSV. In addition, mortality rate, improvement in gas exchange, duration of ventilation, and hospital length of stay were also assessed.


METHODS
This prospective, multi-center, randomized study enrolled 80 patients with ACPE who were randomized to receive nCPAP or nPSV (40 patients in each group) via an oronasal mask. Inclusion criteria were severe dyspnea, respiratory rate > 30 breaths/min, use of respiratory accessory muscles, or PaO(2)/FiO(2) < 200.


RESULTS
ETI was required in 0 (0%) and in 3 (7.5%) patients in the nCPAP group and in the nPSV group, respectively (p = 0.241). No significant difference was observed in in-hospital mortality: 2 (5%) vs. 7 (17.5%) in nCPAP and nPSV groups, respectively (p = 0.154). No difference in hospital length of stay was observed between the two groups, nor was there a difference observed in duration of ventilation, despite a trend for reduced time with nPSV vs. nCPAP (5.91 ± 4.01 vs. 8.46 ± 7.14 h, respectively, p = 0.052). Both nCPAP and nPSV were effective in improving gas exchange, including in the subgroup of hypercapnic patients.


CONCLUSIONS
Both methods are effective treatment for patients with ACPE. Non-invasive CPAP should be considered as the first line of treatment because it is easier to use and less expensive than non-invasive PSV.
Ferrari
Giovanni
G
Department of Emergency Medicine, Ospedale S. Giovanni Bosco, Torino, Italy.
Milan
Alberto
A
Groff
Paolo
P
Pagnozzi
Fiammetta
F
Mazzone
Marinella
M
Molino
Paola
P
Aprà
Franco
F
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D016896:Treatment Outcome