Abstract
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%.
Study 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 PaO2/FiO2 < 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.
Keywords
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Article info
Publication history
Published online: October 09, 2009
Accepted:
July 23,
2009
Received in revised form:
May 29,
2009
Received:
March 30,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
