Non-invasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: a multicenter randomized study in the emergency department.
BACKGROUND
Noninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) are both advocated in the treatment of cardiogenic pulmonary edema (CPE); however, the superiority of one technique over the other has not been clearly demonstrated. With regard to its physiological effects, we hypothesized that NIPSV would be better than CPAP in terms of clinical benefit.


METHODS
In a prospective, randomized, controlled study performed in four emergency departments, 200 patients were assigned to CPAP (n = 101) or NIPSV (n = 99). Primary outcome was combined events of hospital death and tracheal intubation. Secondary outcomes included resolution time, myocardial infarction rate, and length of hospital stay. Separate analysis was performed in patients with hypercapnia and those with high B-type natriuretic peptide (>500 pg/ml).


RESULTS
Hospital death occurred in 5 (5.0%) patients receiving NIPSV and 3 (2.9%) patients receiving CPAP (p = 0.56). The need for intubation was observed in 6 (6%) patients in the NIPSV group and 4 (3.9%) patients in the CPAP group (p = 0.46). Combined events were similar in both groups. NIPSV was associated to a shorter resolution time compared to CPAP (159 ± 54 vs. 210 ± 73 min; p < 0.01), whereas the incidence of new myocardial infarction was not different between both groups. Similar results were found in hypercapnic patients and those with high B-type natriuretic peptide.


CONCLUSIONS
During CPE, NIPSV accelerates the improvement of respiratory failure compared to CPAP but does not affect primary clinical outcome either in overall population or in subgroups of patients with hypercapnia or those with high B-type natriuretic peptide.
Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia. semir.nouira@rns.tn
Semir
S
Nouira
Riadh
R
Boukef
Wahid
W
Bouida
Wieme
W
Kerkeni
Kaouther
K
Beltaief
Hamdi
H
Boubaker
Latifa
L
Boudhib
Mohamed Habib
MH
Grissa
Mohamed Naceur
MN
Trimech
Hamadi
H
Boussarsar
Mehdi
M
Methamem
Soudani
S
Marghli
Mondher
M
Ltaief
D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010102:Oxygen Inhalation Therapy / Q000379:methods; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000191:economics / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy