Reappraisal of Continuous Positive Airway Pressure Therapy in Acute Cardiogenic Pulmonary Edema

Lin, Mike; Yang, Yun-Fu; Chiang, Hung‐Ting; Chang, Mau‐Song; Chiang, Benjamin N.; Cheitlin, M.D.

doi:10.1378/chest.107.5.1379

Cited by 286 publications

(201 citation statements)

References 16 publications

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“…In one study, no improvement in diurnal Pa,O 2 , Pa,CO 2 , arterial bicarbonate concentration or pH, or muscle strength was seen after 2 weeks of oxygen therapy, NIV or NIV plus LTOT, although mean Sa,O 2 increased on oxygen alone and NIV plus oxygen, compared to NIV alone [39]. Sleep quality was most impaired in the NIV limb.…”

Section: Home Mechanical Ventilation In Chronic Obstructive Pulmonarymentioning

confidence: 96%

Home ventilation

Simonds¹

2003

European Respiratory Journal

124

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Section: Home Mechanical Ventilation In Chronic Obstructive Pulmonarymentioning

confidence: 96%

Home ventilation

Simonds¹

2003

European Respiratory Journal

124

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“…[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%

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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“…However, the role of Bi-PAP in patients with ACPE remains controversial. In a comparison of CPAP with Bi-PAP, the latter demonstrated more rapid recovery of respiratory and hemodynamic parameters [19], but Bi-PAP associated with an increased incidence of acute myocardial infarction [14]. Recently, Nouira et al, [20] showed that Bi-PAP improves respiratory failure, while, Masip et al, [21] showed a decrease in intubation rate in Bi-PAP group when compared with CPAP.…”

Section: Introductionmentioning

confidence: 99%

“…However, other studies failed to show these effects [14][15][16]. As compared with CPAP, and oxygen therapy, Bi-PAP reduces the work of breathing and improves gas exchange, dyspnea and respiratory distress more effectively [17,18].…”

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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Reappraisal of Continuous Positive Airway Pressure Therapy in Acute Cardiogenic Pulmonary Edema

Cited by 286 publications

References 16 publications

Home ventilation

Home ventilation

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

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

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