title: Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The evidence of individual studies in acute cardiogenic pulmonary edema (ACPE) supporting noninvasive ventilation (NIV) is still inconclusive, particularly regarding noninvasive positive pressure ventilation (NIPPV).
  
  
  METHODS
  We carried out a meta-analysis. We searched in the Embase, Medline, Cinahl, Dare, Coch, Central, and CNKI databases and congress abstracts for trials comparing continuous positive airway pressure (CPAP) or NIPPV with standard therapy (ST). To assess treatment effects, we carried out direct comparison using a random effects model and adjusted indirect comparison.
  
  
  RESULTS
  At total of 34 studies (3,041 patients) were included. In direct comparisons, both CPAP and NIPPV reduced the risk of death (relative risk [RR] 0.64, 95% CI 0.44-0.93; RR 0.80, 95% CI 0.58-1.10; respectively) compared with ST, although only CPAP had a significant effect. There were no significant differences between NIPPV and CPAP. Pooled results of direct and adjusted indirect comparisons showed that compared with ST, both CPAP and NIPPV significantly reduced mortality (RR 0.63, 95% CI 0.44-0.89; RR 0.73, 95% CI 0.55-0.97; respectively).
  
  
  CONCLUSIONS
  Our findings suggest that among ACPE patients, NIV delivered through either NIPPV or CPAP reduced mortality.
authors.affiliation: Grupo de Estudio, Docencia e Investigación Clínica, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina. ja_mariani@hotmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Mariani
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
authors.forename: César
authors.initials: C
authors.lastname: Belziti
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Deabreu
authors.forename: Juan
authors.initials: J
authors.lastname: Gagliardi
authors.forename: Hernán
authors.initials: H
authors.lastname: Doval
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Carlos
authors.initials: C
authors.lastname: Tajer
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration; D011654:Pulmonary Edema / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome