Noninvasive ventilation in acute cardiogenic pulmonary edema

Newby, David E.; Gray, Alasdair; Goodacre, Steve; Masson, Moyra; Sampson, Fiona; Nicholl, Jon; Benger, Jonathan

Abstract

BACKGROUND Noninvasive ventilation (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure ventilation [NIPPV]) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality. We conducted a study to determine whether non invasive ventilation reduces mortality and whether there are important differences in outcome associated with the method of treatment (CPAP or NIPPV). METHODS In a multicenter, open, prospective, randomized, controlled trial, patients were assigned to standard oxygen therapy, CPAP (5 to 15 cm of water), or NIPPV (inspiratory pressure, 8 to 20 cm of water; expiratory pressure, 4 to 10 cm of water). The primary end point for the comparison between noninvasive ventilation and standard oxygen therapy was death with in 7 days after the initiation of treatment, and the primary end point for the comparison between NIPPV and CPAP was death or intubation within 7 days. RESULT A total of 1069 patients (mean [±SD] age, 77.7±9.7 years; female sex, 56.9%) were assigned to standard oxygen therapy (367 patients), CPAP (346 patients), or NIPPV (356 patients). There was no significant difference in 7-day mortality between patients receiving standard oxygen therapy (9.8%) and those undergoing noninvasive ventilation (9.5%, P = 0.87). There was no significant difference in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation (11.7% for CPAP and 11.1% for NIPPV, P = 0.81). As compared with standard oxygen therapy, noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea (treatment difference, 0.7 on a visual-analogue scale ranging from 1 to 10; 95% confidence interval [CI], 0.2 to 1.3; P = 0.008), heart rate (treatment difference, 4 beats per minute; 95% CI, 1 to 6; P = 0.004), acidosis (treatment difference, pH 0.03; 95% CI, 0.02 to 0.04; P

• Journal Article Type: Article
• Publication Date: Jul 10, 2008
• Journal: New England Journal of Medicine
• Print ISSN: 0028-4793
• Electronic ISSN: 1533-4406
• Publisher: Massachusetts Medical Society
• Peer Reviewed: Not Peer Reviewed
• Volume: 359
• Issue: 2
• Pages: 142-151
• DOI: https://doi.org/10.1056/NEJMoa0707992
• Keywords: noninvasive ventilation, acute cardiogenic pulmonary edema
• Public URL: https://uwe-repository.worktribe.com/output/1010351
• Publisher URL: http://dx.doi.org/10.1056/NEJMoa0707992
• Additional Information: Corporate Creators : For the 3CPO Trialists