Randomized Trial of Bilevel versus Continuous Positive Airway Pressure for Acute Pulmonary Edema

Liesching, Timothy; Nelson, David L.; Cormier, Karen; Sucov, Andrew; Short, Kathy A.; Warburton, Rod R.; Hill, Nicholas S.

doi:10.1016/j.jemermed.2013.08.015

Cited by 37 publications

(18 citation statements)

References 37 publications

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“…These results were similar to previous studies [24,35]. Moreover, systematic review and meta-analysis conducted by Hui et al, [36] reported no differences in mortality, intubation rate, and length of stay in the hospital between Bi-PAP and CPAP.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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

El-Refay¹

2015

CMR

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“…To the best of our knowledge, this is the largest study to investigate dyspnoea in a population of non-intubated patients admitted for ARF and treated with NIV. Dyspnoea has been measured as a secondary outcome in many trials evaluating the benefit of NIV in acute-on-chronic respiratory failure and acute cardiogenic pulmonary oedema [11][12][13][14], and as a primary outcome in a trial on NIV in end-of-life patients [15]. However, the prevalence of dyspnoea and its risk factors and prognostic impact have not been previously studied in such a large population.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, dyspnoea is one of the key symptoms of ARF that may also be modulated by NIV. Some data indirectly suggest that dyspnoea may be frequent and severe in patients receiving NIV and could be improved in response to NIV [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Dyspnoea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact

et al. 2018

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Dyspnoea is a frequent and intense symptom in intubated patients, but little attention has been paid to dyspnoea during noninvasive mechanical ventilation in the intensive care unit (ICU).The objectives of this study were to quantify the prevalence, intensity and prognostic impact of dyspnoea in patients receiving noninvasive ventilation (NIV) for acute respiratory failure (ARF) based on secondary analysis of a prospective observational cohort study in patients who received ventilatory support for ARF in 54 ICUs in France and Belgium. Dyspnoea was measured by a modified Borg scale.Among the 426 patients included, the median (interquartile range) dyspnoea score was 4 (3-5) on admission and 3 (2-4) after the first NIV session (p=0.001). Dyspnoea intensity ≥4 after the first NIV session was associated with the Sequential Organ Failure Assessment Score (odds ratio (OR) 1.12, p=0.001), respiratory rate (OR 1.03, p=0.032), anxiety (OR 1.92, p=0.006), leaks (OR 2.5, p=0.002) and arterial carbon dioxide tension (OR 0.98, p=0.025). Dyspnoea intensity ≥4 was independently associated with NIV failure (OR 2.41, p=0.001) and mortality (OR 2.11, p=0.009), but not with higher post-ICU burden and altered quality of life.Dyspnoea is frequent and intense in patients receiving NIV for ARF and is associated with a higher risk of NIV failure and poorer outcome.

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“…A recent trial showed that biPAP more rapidly improves oxygenation and dyspnoea scores, and reduces the need for ICU admission when compared to CPAP (31).…”

Section: Effects On Oxygenationmentioning

confidence: 99%

Cardiorespiratory interaction with continuous positive airway pressure

Pengo¹,

Bonafini²,

Fava³

et al. 2018

J. Thorac. Dis.

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The treatment of choice for obstructive sleep apnoea (OSA) is continuous positive airway pressure therapy (CPAP). Since its introduction in clinical practice, CPAP has been used in various clinical conditions with variable and heterogeneous outcomes. In addition to the well-known effects on the upper airway CPAP impacts on intrathoracic pressures, haemodynamics and blood pressure (BP) control. However, short- and long-term effects of CPAP therapy depend on multiple variables which include symptoms, underlying condition, pressure used, treatment acceptance, compliance and usage. CPAP can alter long-term cardiovascular risk in patients with cardiorespiratory conditions. Furthermore, the effect of CPAP on the awake patient differs from the effect on the patients while asleep, and this might contribute to discomfort and removal of the use interface. The purpose of this review is to highlight the physiological impact of CPAP on the cardiorespiratory system, including short-term benefits and long-term outcomes.

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Randomized Trial of Bilevel versus Continuous Positive Airway Pressure for Acute Pulmonary Edema

Cited by 37 publications

References 37 publications

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

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

Dyspnoea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact

Cardiorespiratory interaction with continuous positive airway pressure

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