Non-invasive positive pressure ventilation for cardiogenic pulmonary edema

Vital FMR, Saconato H, Ladeira MT, Sen A, Hawkes CA, Soares B, Burns KE. A., Atallah ÁN

Published Online:

July 16, 2008

Acute heart failure is a problem of high incidence in general population and may culminate in acute cardiogenic pulmonary edema (ACPE). This review aimed to determine the effectiveness and safety of non-invasive positive pressure ventilation (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care, compared with standard medical care alone in adults with ACPE. We included 21 studies involving 1,071 participants. Results from randomized controlled trials demonstrate that the use of NPPV, especially CPAP, reduces mortality, endotracheal intubation rate and intensive care unit length of stay without increasing the risk of heart attack during or after treatment.

Abstract (click to read)

Background:

Non-invasive positivepressure ventilation (NPPV) has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing.

Objectives:

To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary edema.

Search strategy:

We undertook a comprehensive search of the following databases in April 2005: CENTRAL, MEDLINE, EMBASE, CINAHL, DARE and LILACS. We also reviewed reference lists of included studies and contacted experts, equipment manufacturers, and the Cochrane Heart Group. We did not apply language restrictions.

Selection criteria:

We selected blinded or unblinded randomized or quasi-randomized clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and where NPPV (continuous positive airway pressure (CPAP)) and/or bilevel NPPV plus standard medical care was compared with standard medical care alone.

Data collection and analysis:

Two authors independently selected articles and abstracted data using a standardized data collection form. We evaluated study quality with emphasis on allocation concealment, adherence to the intention-to-treat principle and losses to follow-up.

Main results:

We included 21 studies involving 1,071 participants. Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83) with numbers needed to treat of 13 and 8, respectively. We found no difference in hospital length of stay with NPPV, however, intensive care unit stay was reduced by 1 day (WMD -1.07 days, 95% CI -1.60 to -0.53). Compared to standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.82, 95% CI 0.09 to 7.54) its application.

Authors' conclusions:

NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.

This record should be cited as:

Vital FMR, Saconato H, Ladeira MT, Sen A, Hawkes CA, Soares B, Burns KE. A., Atallah ÁN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005351. DOI: 10.1002/14651858.CD005351.pub2

Assessed as up to date:

April 29, 2005

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Primary Review Group:

Heart Group

Health topics:

Heart & circulation > Heart failure > Acute heart failure

Anaesthesia & pain control > Ventilation in peri-anaesthetic/critical care

Lungs & airways > Ventilation in peri-anaesthetic/critical care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Non-invasive positive pressure ventilation for cardiogenic pulmonary edema

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