Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema*

Park, Marcelo; Sangean, Márcia Cristina; Volpe, Marcia de S.; Feltrim, Maria Ines Zanetti; Nozawa, Emı́lia; Leite, Paulo Ferreira; Amato, Marcelo B. P.; Lorenzi‐Filho, Geraldo

doi:10.1097/01.ccm.0000147770.20400.10

Cited by 238 publications

(155 citation statements)

References 27 publications

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“…This result compares favourably with the study by Kosowsky et al, reporting an in hospital intubation rate of 7 out of 19 (37%). Intubation rate and overall mortality of the present study is in line with recent reports on the in-hospital [4,[7][8][9][10]27] and out-hospital [12] application of CPAP and Pressure Support Ventilation in ACPE. Oxygen saturation improved, respiratory rate, heart rate, and blood pressure decreased in both groups.…”

Section: Efficacy Of Helmet Cpapsupporting

confidence: 80%

“…[2][3][4][5][6][7][8][9][10]. Despite this background, reports of CPAP application in prehospital setting are, to our knowledge quite limited.…”

Section: Out Of Hospital Use Of Cpapmentioning

confidence: 99%

“…In hospital, non-invasive Continuous Positive Airway pressure (CPAP) has proven effective in ameliorating gas exchange and reducing both the need for endotracheal intubation and the overall mortality of patients with ACPE, as suggested by randomized controlled trials and a recent meta-analysis [2][3][4][5][6][7][8][9][10], although this result has been challenged by a large multicenter trial. [11] With the understanding that immediate advanced medical care is essential to improve the long-term outcome of cardiac patients, we developed a program for the pre-hospital application of CPAP.…”

Section: Introductionmentioning

confidence: 99%

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Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

et al. 2008

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PURPOSE: Non invasive Continuous Positive Airway Pressure (CPAP) is effective in reducingintubation rate and mortality of patient with Acute Cardiogenic Pulmonary Edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE. METHODS: In pre-hospital treatment of 62 patients with presumed ACPE, CPAP was added to standard medical treatment while in another 59 patients, CPAP was used as a sole therapy . RESULTS: Helmet CPAP was feasible in all patients. No patient required pre-hospital intubation. In both groups, CPAP significantly improved oxygenation (SpO 2 went from 79 ± 12 % to 97 ± 3% and from 81 ± 13 % to 98 ± 3 %), reduced respiratory rate (from 26 ± 4 to 21 ± 3 bpm and from 30 ± 9 to 22 ± 8 bpm) and improved hemodynamics, with a more pronounced decrease in blood pressure in the group with medical treatment than in the one without it. In the two cohorts, four and five patients were respectively intubated in Emergency Department and eleven and nine eventually died. CONCLUSIONS:Helmet CPAP is feasible, efficient and safe in pre-hospital treatment of presumed ACPE. A significant improvement of physiological variables was observed also in the group treated with CPAP in absence of a drug therapy. We propose helmet CPAP as first line prehospital treatment of presumed severe ACPE.

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Section: Efficacy Of Helmet Cpapsupporting

confidence: 80%

“…[2][3][4][5][6][7][8][9][10]. Despite this background, reports of CPAP application in prehospital setting are, to our knowledge quite limited.…”

Section: Out Of Hospital Use Of Cpapmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

et al. 2008

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“…In a subsequent randomized study, Bellone et al [26], however, concluded that CPAP and NIPPSV were equivalent in terms of clinical parameters improvement, but also in terms of myocardial infarction rate or troponin plasma levels increase. In all subsequent clinical comparisons, both CPAP and NIPPSV proved superior to medical therapy alone in terms of reducing the intubation rate [27,28], without any adverse event rate or outcome differences.…”

mentioning

confidence: 92%

Is the noninvasive ventilatory mode of importance during cardiogenic pulmonary edema?

L’Her

2010

Intensive Care Med

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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%

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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Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema*

Abstract: Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.

Cited by 238 publications

References 27 publications

Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

Is the noninvasive ventilatory mode of importance during cardiogenic pulmonary edema?

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

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