Gerasimos Filippatos, MD; Alexander Mebazaa, MD; Josep Masip, MD
In patients with acute cardiogenic pulmonary edema, do noninvasive intermittent positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP) reduce mortality? Is NIPPV better than CPAP?
Randomized controlled trial (Three interventions in Cardiogenic Pulmonary Oedema [3CPO]).
Unclear allocation concealment.*
26 emergency departments in hospitals in the UK.
1156 patients > 16 years of age (mean age 78 y, 57% women based on 1069 patients) who had acute cardiogenic pulmonary edema, shown by chest radiograph, respiratory rate > 20 breaths/min, and arterial pH < 7.35. Exclusion criteria included need for lifesaving or emergency intervention and past recruitment to the trial.
346 patients were allocated to noninvasive ventilation (NIV) using CPAP (5 to 15 cm H2O), 356 to NIV using NIPPV (inspiratory pressure 8 to 20 cm H2O, expiratory pressure 4 to 10 cm H2O), and 367 to standard oxygen therapy. CPAP and NIPPV were given through a full face mask with supplemental oxygen, and standard oxygen therapy was given through a variable delivery mask with reservoir.
Mortality at 7 days and a composite of mortality or endotracheal intubation at 7 days. Other outcomes included mortality at 30 days and change in patient-reported dyspnea at 1 hour after treatment (visual analogue scale, 0 = no breathlessness, 10 = maximum breathlessness).
92% at 7 days and 88% at 30 days (intention-to-treat analysis).
The main outcomes are shown in the Table. NIV improved dyspnea more than standard oxygen therapy at 1 hour (mean difference in dyspnea score 0.7, 95% CI 0.2 to 1.3); CPAP and NIPPV did not differ (mean difference −0.2, CI −0.8 to 0.4).
In patients with acute cardiogenic pulmonary edema, noninvasive ventilation improved dyspnea but did not reduce short-term mortality.
Noninvasive intermittent positive pressure ventilation (NIPPV) vs continuous positive airway pressure (CPAP) vs standard oxygen therapy in acute cardiogenic pulmonary edema†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
Filippatos G, Mebazaa A, Masip J. Noninvasive ventilation improved dyspnea but did not reduce short-term mortality in acute cardiogenic pulmonary edema. Ann Intern Med. 2008;149:JC6–9. doi: 10.7326/0003-4819-149-12-200812160-02009
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Published: Ann Intern Med. 2008;149(12):JC6-9.
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