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01-05-2008 | Original

Continuous positive airway pressure vs. proportional assist ventilation for noninvasive ventilation in acute cardiogenic pulmonary edema

Authors: Thierry Rusterholtz, Pierre-Edouard Bollaert, Marc Feissel, Florence Romano-Girard, Marie-Line Harlay, Michel Zaehringer, Benjamin Dusang, Philippe Sauder

Published in: Intensive Care Medicine | Issue 5/2008

Abstract

Objective

To compare continuous positive airway pressure (CPAP) and proportional assist ventilation (PAV) as modes of noninvasive ventilatory support in patients with severe cardiogenic pulmonary edema.

Design and setting

A prospective multicenter randomized study in the medical ICUs of three teaching hospitals.

Patients

Thirty-six adult patients with cardiogenic pulmonary edema (CPA) with unresolving dyspnea, respiratory rate above 30/min and/or SpO₂ above 90% with O₂ higher than 10 l/min despite conventional therapy with furosemide and nitrates.

Interventions

Patients were randomized to undergo either CPAP (with PEEP 10 cmH₂O) or PAV (with PEEP 5–6 cmH₂O) noninvasive ventilation through a full face mask and the same ventilator.

Measurements and results

The main outcome measure was the failure rate as defined by the onset of predefined intubation criteria, severe arrythmias or patient's refusal. On inclusion CPAP (n = 19) and PAV (n = 17) groups were similar with regard to age, sex ratio, type of heart disease, SAPS II, physiological parameters (mean arterial pressure, heart rate, blood gases), amount of infused nitrates and furosemide. Failure was observed in 7 (37%) CPAP and 7 (41%) PAV patients. Among these, 4 (21%) CPAP and 5 (29%) PAV patients required endotracheal intubation. Changes in physiological parameters were similar in the two groups. Myocardial infarction and ICU mortality rates were strictly similar in the two groups.

Conclusions

In the present study PAV was not superior to CPAP for noninvasive ventilation in severe cardiogenic pulmonary edema with regard to either efficacy and tolerance.

International Consensus Conference in Intensive Care Medicine (2001) Noninvasive positive pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 163:283–291

British Thoracic Society Standards of Care Committee (2002) Non-invasive ventilation in acute respiratory failure. Thorax 57:192–211CrossRef

Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema. JAMA 294:3124–3130PubMedCrossRef

Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD (2006) Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary edema: a meta-analysis. Lancet 367:1155–1163PubMedCrossRef

Winck J, Azevedo LF, Costa-Pereira A, Antonelli M, Wyatt JC (2006) Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonaty edema—a systematic review and meta-analysis. Crit Care 10:R69PubMedCrossRef

Räsänen J, Heikkila J, Downs SJ, Nikki P, Väisanen I, Vitanen A (1985) Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol 55:296–300PubMedCrossRef

Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ (1991) Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 325:1825–1830PubMedCrossRef

Lin M, Yang YF, Chiang HT, Chang MS, Chiang BN, Cheitlin MD (1995) Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Chest 107:1379–1386PubMedCrossRef

Kelly CA, Newby DE, McDonagh TA, Mackay TW, Barr J, Boon NA, Dargie HJ, Douglas NJ (2002) Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. Effects on plasma brain natriuretic peptide oedema. Eur Heart J 23:1379–1386PubMedCrossRef

10.

L'Her E, Duquesne F, Girou E, Donin de Rosière X, Le Conte P, Renault S, Allamy JP, Boles JM (2004) Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients. Intensive Care Med 30:882–888PubMedCrossRef

11.

Masip J, Betbese AJ, Paez J, Vecilla F, Canizares R, Padro J, Paz MA, de Otero J, Ballus J (2000) Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 356:2126–2132PubMedCrossRef

12.

Nava S, Carbone G, DiBattista N, Bellone A, Baiardi P, Cosentini R, Marenco M, Giostra F, Borasi G, Groff P (2003) Noninvasive ventilation in cardiogenic pulmonary edema. Am J Respir Crit Care Med 168:1432–1437PubMedCrossRef

13.

Levitt MA (2001) A Prospective, randomized trial of BiPAP in severe acute congestive heart failure. J Emerg Med 21:363–369PubMedCrossRef

14.

Chadda K, Annane D, Hart N, Gajdos P, Raphaël JC, Lofaso F (2002) Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema. Crit Care Med 30:2457–2461PubMedCrossRef

15.

Mehta S, Jay GD, Woolard RH, Hipona RA, Connolly EM, Cimini DM, Drinkwine JH, Hill NS (1997) Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 25:620–628PubMedCrossRef

16.

Park M, Sangean MC, Volpe MdeS, Feltrim MI, Nozawa E, Leite PF, Passos Amato MB, Lorenzi-Filho G (2004) Randomized, prospective trial of oxygen, continuous positive airway pressure and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med 32:2407–2415PubMedCrossRef

17.

Bellone A, Monari A, Cortellaro F, Vettorello M, Arlati S, Coen D (2004) Myocardial infarction rate in acute pulmonary edema: noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 32:1860–1868PubMedCrossRef

18.

Crane SD, Elliott MW, Gilligan P, Richards K, Gray AJ (2004) Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema. Emerg Med 21:155–161CrossRef

19.

Bellone A, Vettorello M, Monari A, Cortevallo F, Coen D (2005) Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema. Intensive Care Med 31:807–811PubMedCrossRef

20.

Bersten AD (2003) Noninvasive ventilation for cardiogenic pulmonary edema: froth and bubbles? Am J Respir Crit Care Med 168:1406–1407PubMedCrossRef

21.

Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support. Am Rev Respir Dis 145:114–120PubMed

22.

Fernandez-Vivas M, Caturla-Such J, Gonzalez de la Rosa J, Acosta-Escribano J, Alvarez-Sanchez B, Canovas-Robles J (2003) Noninvasive pressure support versus proportional assist ventilation in acute respiratory failure. Intensive Care Med 29:1126–1133PubMedCrossRef

23.

Gay PC, Hess DR, Hill NS (2001) Noninvasive proportional assist ventilation for acute respiratory insufficiency. Comparison with pressure support ventilation. Am J Respir Crit Care Med 164:1606–1611PubMed

24.

Porta R, Appendini L, Vitacca M, Bianchi L, Donner CF, Poggi R, Ambrosino N (2002) Mask proportional assist vs. pressure support ventilation in patients in clinically stable condition with chronic ventilatory failure. Chest 122:479–488PubMedCrossRef

25.

Ranieri VM, Grasso S, Mascia L, Martino S, Tommasco F, Brienza A, Giuliani R (1997) Effects of proportional assist ventilation on inspiratory muscle effort in patients with chronic obstructive pulmonary disease and acute respiratory failure. Anesthesiology 86:79–91PubMedCrossRef

26.

Wysocki M, Richard JC, Meshaka P (2002) Noninvasive proportional assist ventilation compared with noninvasive pressure support ventilation in hypercapnic acute respiratory failure. Crit Care Med 30:323–329PubMedCrossRef

27.

Polese G, Vitacca M, Bianchi L, Rossi A, Ambrosino N (2000) Nasal proportional assist ventilation unloads the inspiratory muscles of stable patients with hypercapnia due do COPD. Eur Respir J 16:491–498PubMedCrossRef

28.

Vittacca M, Clini E, Pagani M, Bianchi L, Rossi A, Ambrosino N (2000) Physiologic effects of early administered mask proportional assist ventilation in patients with chronic obstructive pulmonary disease and acute pulmonary failure. Crit Care Med 28:1791–1797CrossRef

29.

Patrick W, Webster K, Ludwig L, Roberts D, Wiebe P, Younes M (1996) Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure. Am J Respir Crit Care Med 153:1005–1011PubMed

30.

Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Benefits and risks of success or failure in noninvasive ventilation. Intensive Care Med 32:1756–1762PubMedCrossRef

31.

Aubier M, Viires N, Syllie G, Mozes R, Roussos C (1982) Respiratory muscle contribution to lactic acidosis in low cardiac output. Am Rev Respir Dis 126:648–652PubMed

32.

Masip J, Pena C, Figueras J, Pàez J, Sànchez B, Cancio B (2005) Hypertensive acute pulmonary edema. Eur J Heart Fail 4 [Suppl 1]:11

33.

Younes M, Puddy A, Roberts D, Light B, Quesada A, Taylor K, Oppenheimer L, Cramp H (1992) Proportional assist ventilation, results of an initial clinical trial. Am Rev Respir Dis 145:121–129PubMed

34.

Lenique F, Habis M, Lofaso F, Dubois-Randé JL, Harf A, Brochard L (1997) Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 155:500–505PubMed

Title: Continuous positive airway pressure vs. proportional assist ventilation for noninvasive ventilation in acute cardiogenic pulmonary edema
Authors: Thierry Rusterholtz
Pierre-Edouard Bollaert
Marc Feissel
Florence Romano-Girard
Marie-Line Harlay
Michel Zaehringer
Benjamin Dusang
Philippe Sauder
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-0998-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Continuous positive airway pressure vs. proportional assist ventilation for noninvasive ventilation in acute cardiogenic pulmonary edema

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

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