Continuous positive airway pressure for cardiogenic pulmonary edema: a randomized study.
OBJECTIVE
The purpose of this randomized controlled trial was to determine the immediate and delayed effects of noninvasive ventilation for patients in acute cardiogenic pulmonary edema (ACPE) in addition to aggressive usual care in a medical prehospital setting.


METHODS
Out-of-hospital patients in severe ACPE were eligible for the study. Patients were randomized to receive either usual care, including conventional optimal treatment with furosemide, oxygen, and high-dose boluses of isosorbide dinitrate plus oxygen, or conventional medications plus out-of-hospital continuous positive airway pressure (CPAP). The primary outcome was the treatment success defined as all of respiratory rate less than 25 breaths per minute and oxygen saturation of greater than 90% at the end of 1-hour study. Secondary end points included death during 30 days after inclusion. Lengths of intensive care unit and hospital stays were also recorded.


RESULTS
In total, 124 patients were enrolled into the study. The 2 groups had similar baseline characteristics. For the primary outcome analysis, 22 (35.5%) of 62 patients were considered as experiencing a treatment success in the usual care group vs 19 (31.7%) of 60 in the CPAP group (P = .65). Seven patients died within 30 days in the usual care group vs 6 in the CPAP group (P = .52). There were no statistically significant differences between the treatment groups for length of stay either in hospital or in the intensive care unit.


CONCLUSIONS
In the prehospital setting, in spite of its potential advantages for patients in ACPE, CPAP may not be preferred to a strict optimal intravenous treatment.
Frontin
Philippe
P
SAMU 31, Pôle de médecine d'urgences, Hôpitaux Universitaires, 31059 Toulouse cedex 9, France.
Bounes
Vincent
V
Houzé-Cerfon
Charles Henri
CH
Charpentier
Sandrine
S
Houzé-Cerfon
Vanessa
V
Ducassé
Jean Louis
JL
D000368:Aged; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D011654:Pulmonary Edema / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D004232:Diuretics; D014665:Vasodilator Agents; D005665:Furosemide; D007548:Isosorbide Dinitrate; D010100:Oxygen