Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

Park, Marcelo; Lorenzi‐Filho, Geraldo; Feltrim, Maria Ines Zanetti; Viecili, Paulo Ricardo Nazário; Sangean, Márcia Cristina; Volpe, Marcia de S.; Leite, Paulo Ferreira; Mansur, Alfredo José

doi:10.1590/s0066-782x2001000300005

Cited by 45 publications

(43 citation statements)

References 17 publications

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“…45,54,57,59,61,62 or all three of these treatments. 50,56,64,65 Before publication of a recent large RCT, 65 which accounted for 40% of all patients who have been studied in RCTs of continuous positive airway pressure for cardiogenic pulmonary edema and 70% of patients receiving noninvasive positive-pressure ventilation for this indication, five separate systematic reviews [162][163][164][165][166] had consistently demonstrated a significant reduction in endotracheal intubation with both types of noninvasive ventilation. When this large trial was included in the metaanalysis, there was a trend toward reduction in endotracheal intubation with noninvasive positive-pressure ventilation (RR 0.55, 95% CI 0.29-1.03) and a significant reduction in endotracheal intubation with continuous positive airway pressure by mask (RR 0.42, 95% CI 0.28-0.63) relative to oxygen alone.…”

Section: Cardiogenic Pulmonary Edemamentioning

confidence: 99%

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Keenan¹,

Sinuff²,

Burns³

et al. 2011

Canadian Medical Association Journal

320

192

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Section: Cardiogenic Pulmonary Edemamentioning

confidence: 99%

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Keenan¹,

Sinuff²,

Burns³

et al. 2011

Canadian Medical Association Journal

320

192

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“…Continuous positive airway pressure is an effective treatment for the failing heart, not only because it inflates the lungs but also because it augments cardiac performance by decreasing pre and after load. 69,70 On the other hand, the recent observation that Cheyne-Stokes respiration is more frequent in the supine position is compelling evidence that upper airway instability does play a role in the aggravation of the respiration, at least in some patients.…”

Section: Contributing Factors To Respiratory Instabilitymentioning

confidence: 99%

Cheyne-Stokes Respiration in Patients With Congestive Heart Failure: Causes and Consequences

Lorenzi-Filho¹,

Genta

Figueiredo

et al. 2005

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Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO 2 (PaCO 2 ) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

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“…Over the past three decades, application of noninvasive ventilation (NIV) either with continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (Bi-PAP) has been used with the standardized medical treatment as an effective therapeutic approach to treat ACPE [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…The goals of NIV use in the treatment of ACPE are to improve oxygenation, reduce the effort of breathing and increase cardiac output and decreased left ventricular preand after-load [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

El-Refay¹

2015

CMR

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Abstract:This study was to compare the efficacy of continuous, bi-level positive airway pressure (CPAP, Bi-PAP) and oxygen therapy on detailed observation of time-course change in blood gases, physiological parameters and rate of endotracheal intubation in patient with acute cardiogenic pulmonary edema (ACPE). Sixty-six patients with ACPE were randomly assigned to receive standard oxygen (O 2 ) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO 2 , PaO 2 , SaO 2 , pH, and HCO 3 ), and physiological parameters (HR, RR, SBP, and DBP) were collected at baseline (T0), immediately after 60 minutes (T60), and after 30 minutes of discontinuation (T90). A significant improvements (p<0.05) in PaCO 2 , PaO 2 , SaO 2 and vital signs were observed immediately after CPAP and Bi-PAP when compared to O 2 therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO 2 , SaO 2 , and respiratory rate. No differences on intubation and death rate detected among treatment groups. Both methods of noninvasive ventilations are effective treatment for ACPE. However, Bi-PAP should be considered as first line of treatment due to faster and continuous improvement in oxygenation and respiratory rate.

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Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

Abstract: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

Cited by 45 publications

References 17 publications

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Cheyne-Stokes Respiration in Patients With Congestive Heart Failure: Causes and Consequences

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

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