Non-Invasive Mechanical Ventilation Versus Continuous Positive Airway Pressure Relating to Cardiogenic Pulmonary Edema in an Intensive Care Unit |
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| Affiliation: | 1. Emergency Medicine, University of Helsinki, Department of Emergency Care, Helsinki University Hospital, Helsinki, Finland;2. Helsinki University Hospital, Heart and Lung Center, Division of Cardiology, Helsinki, Finland;3. Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona, Spain;4. Rigshospitalet, Copenhagen University Hospital, Intensive Cardiac Care Unit, Copenhagen, Denmark;5. Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland;6. Attikon University Hospital, Heart Failure Clinic and Secondary Cardiology Department, Athens, Greece;7. University Hospital Brno, Department of Internal Medicine and Cardiology, Brno, Czech Republic;8. University of Porto, CINTESIS, Department of Cardiology, Porto Medical School, São João Hospital Center, Porto, Portugal;9. Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy;10. Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Medicine Sant''Andrea Hospital, Rome, Italy;11. University of Barcelona, Hospital Sant Joan Despi Moisès Broggi, Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain |
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| Abstract: | BackgroundTo compare the application of non-invasive ventilation (NIV) versus continuous positive airway pressure (CPAP) in the treatment of patients with cardiogenic pulmonary edema (CPE) admitted to an intensive care unit (ICU).MethodsIn a prospective, randomized, controlled study performed in an ICU, patients with CPE were assigned to NIV (n=56) or CPAP (n=54). Primary outcome was intubation rate. Secondary outcomes included duration of ventilation, length of ICU and hospital stay, improvement of gas exchange, complications, ICU and hospital mortality, and 28-day mortality. The outcomes were analyzed in hypercapnic patients (PaCO2 > 45 mmHg) with no underlying chronic lung disease.ResultsBoth devices led to similar clinical and gas exchange improvement; however, in the first 60 min of treatment a higher PaO2/FiO2 ratio was observed in the NIV group (205±112 in NIV vs. 150±84 in CPAP, P=.02). The rate of intubation was similar in both groups (9% in NIV vs. 9% in CPAP, P=1.0). There were no differences in duration of ventilation, ICU and length of hospital stay. There were no significant differences in ICU, hospital and 28-d mortality between groups. In the hypercapnic group, there were no differences between NIV and CPAP.ConclusionsEither NIV or CPAP are recommended in patients with CPE in the ICU. Outcomes in the hypercapnic group with no chronic lung disease were similar using NIV or CPAP. |
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| Keywords: | Noninvasive ventilation Continuous positive airway pressure Cardiogenic pulmonary edema Acute respiratory failure Ventilación no invasiva Presión positiva continua en la vía aérea Edema agudo de pulmón cardiogénico Insuficiencia respiratoria aguda |
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