Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 2/2006

Open Access 01-04-2006 | Research

A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis

Authors: Kwok M Ho, Karen Wong

Published in: Critical Care | Issue 2/2006

Login to get access

Abstract

Introduction

We conducted the present study to investigate the potential beneficial and adverse effects of continuous positive airway pressure (CPAP) compared with bi-level positive airway pressure (BiPAP) noninvasive ventilation in patients with cardiogenic pulmonary oedema.

Method

We included randomized controlled studies comparing CPAP and BiPAP treatment in patients with cardiogenic pulmonary oedema from the Cochrane Controlled Trials Register (2005 issue 3), and EMBASE and MEDLINE databases (1966 to 1 December 2005), without language restriction. Two reviewers reviewed the quality of the studies and independently performed data extraction.

Results

Seven randomized controlled studies, including a total of 290 patients with cardiogenic pulmonary oedema, were considered. The hospital mortality (relative risk [RR] 0.76, 95% confidence interval [CI] 0.32–1.78; P = 0.52; I2 = 0%) and risk for requiring invasive ventilation (RR 0.80, 95% CI 0.33–1.94; P = 0.62; I2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. Stratifying studies that used either fixed or titrated pressure during BiPAP treatment and studies involving patients with or without hypercapnia did not change the results. The duration of noninvasive ventilation required until the pulmonary oedema resolved (weighted mean difference [WMD] in hours = 3.65, 95% CI -12.12 to +19.43; P = 0.65, I2 = 0%) and length of hospital stay (WMD in days = -0.04, 95% CI -2.57 to +2.48; P = 0.97, I2 = 0%) were also not significantly different between the two groups. Based on the limited data available, there was an insignificant trend toward an increase in new onset acute myocardial infarction in patients treated with BiPAP (RR 2.10, 95% CI 0.91–4.84; P = 0.08; I2 = 25.3%).

Conclusion

BiPAP does not offer any significant clinical benefits over CPAP in patients with acute cardiogenic pulmonary oedema. Until a large randomized controlled trial shows significant clinical benefit and cost-effectiveness of BiPAP versus CPAP in patients with acute cardiogenic pulmonary oedema, the choice of modality will depend mainly on the equipment available.
Appendix
Available only for authorised users
Literature
1.
Kosowsky JM, Storrow AB, Carleton SC: Continuous and bilevel positive airway pressure in the treatment of acute cardiogenic pulmonary edema. Am J Emerg Med 2000, 18: 91-95. 10.1016/S0735-6757(00)90059-7CrossRefPubMed
2.
L'Her E, Duquesne F, Girou E, de Rosiere XD, Le Conte P, Renault S, Allamy JP, Boles JM: Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients. Intensive Care Med 2004, 30: 882-888. 10.1007/s00134-004-2183-yCrossRefPubMed
3.
Lin M, Yang YF, Chiang HT, Chang MS, Chiang BN, Cheitlin MD: Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Short-term results and long-term follow-up. Chest 1995, 107: 1379-1386.CrossRefPubMed
4.
Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ: Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991, 325: 1825-1830.CrossRefPubMed
5.
Agarwal R, Aggarwal AN, Gupta D, Jindal SK: Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J 2005, 81: 637-643. 10.1136/pgmj.2004.031229PubMedCentralCrossRefPubMed
6.
Chadda K, Annane D, Hart N, Gajdos P, Rapael JC, Lofaso F: Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema. Crit Care Med 2002, 30: 2457-2461. 10.1097/00003246-200211000-00009CrossRefPubMed
7.
Masip J, Betbese AJ, Paez J, Vecilla F, Canizares R, Padro J, Paz MA, de Otero J, Ballus J: Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 2000, 356: 2126-2132. 10.1016/S0140-6736(00)03492-9CrossRefPubMed
8.
Nava S, Carbone G, DiBattista N, Bellone A, Baiardi P, Cosentini R, Marenco M, Giostra F, Borasi G, Groff P: Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 2003, 168: 1432-1437. 10.1164/rccm.200211-1270OCCrossRefPubMed
9.
Mehta S, Jay GD, Woolard RH, Hipona RA, Connolly EM, Cimini DM, Drinkwine JH, Hill NS: Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 1997, 25: 620-628. 10.1097/00003246-199704000-00011CrossRefPubMed
10.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996, 17: 1-12. 10.1016/0197-2456(95)00134-4CrossRefPubMed
11.
12.
13.
Masip J, Paez J, Merino M, Parejo S, Vecilla F, Riera C, Rios A, Sabater J, Ballus J, Padro J: Risk factors for intubation as a guide for noninvasive ventilation in patients with severe acute cardiogenic pulmonary edema. Intensive Care Med 2003, 29: 1921-1928. 10.1007/s00134-003-1922-9CrossRefPubMed
14.
Park M, Lorenzi-Filho G, Feltrim MI, Viecili PR, Sangean MC, Volpe M, Leite PF, Mansur AJ: Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema. Arq Bras Cardiol 2001, 76: 221-230. 10.1590/S0066-782X2001000300005CrossRefPubMed
15.
Park M, Sangean MC, Volpe Mde S, Feltrim MI, Nozawa E, Leite PF, Passos Amato MB, Lorenzi-Filho G: 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 2004, 32: 2407-2415. 10.1097/01.CCM.0000147770.20400.10CrossRefPubMed
16.
Cross AM, Cameron P, Kierce M, Ragg M, Kelly AM: Non-invasive ventilation in acute respiratory failure: a randomised comparison of continuous positive airway pressure and bi-level positive airway pressure. Emerg Med J 2003, 20: 531-534. 10.1136/emj.20.6.531PubMedCentralCrossRefPubMed
17.
Bellone A, Vettorello M, Monari A, Cortellaro F, Coen D: Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema. Intensive Care Med 2005, 31: 807-811. 10.1007/s00134-005-2649-6CrossRefPubMed
18.
Bellone A, Monari A, Cortellaro F, Vettorello M, Arlati S, Coen D: Myocardial infarction rate in acute pulmonary edema: noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 2004, 32: 1860-1865. 10.1097/01.CCM.0000139694.47326.B6CrossRefPubMed
19.
Crane SD, Elliott MW, Gilligan P, Richards K, Gray AJ: 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 J 2004, 21: 155-161. 10.1136/emj.2003.005413PubMedCentralCrossRefPubMed
20.
Philip-Joet FF, Paganelli FF, Dutau HL, Saadjian AY: Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure. Respiration 1999, 66: 136-143. 10.1159/000029355CrossRefPubMed
21.
Sharon A, Shpirer I, Kaluski E, Moshkovitz Y, Milovanov O, Polak R, Blatt A, Simovitz A, Shaham O, Faigenberg Z, et al.: High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol 2000, 36: 832-837. 10.1016/S0735-1097(00)00785-3CrossRefPubMed
22.
Levitt MA: A prospective, randomized trial of BiPAP in severe acute congestive heart failure. J Emerg Med 2001, 21: 363-369. 10.1016/S0736-4679(01)00385-7CrossRefPubMed
23.
Acosta B, DiBenedetto R, Rahimi A, Acosta MF, Cuadra O, Van Nguyen A, Morrow L: Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction. Chest 2000, 118: 1004-1009. 10.1378/chest.118.4.1004CrossRefPubMed
24.
Hoffmann B, Welte T: The use of noninvasive pressure support ventilation for severe respiratory insufficiency due to pulmonary oedema. Intensive Care Med 1999, 25: 15-20. 10.1007/s001340050781CrossRefPubMed
25.
Valipour A, Cozzarini W, Burghuber OC: Non-invasive pressure support ventilation in patients with respiratory failure due to severe acute cardiogenic pulmonary edema. Respiration 2004, 71: 144-151. 10.1159/000076675CrossRefPubMed
26.
Rusterholtz T, Kempf J, Berton C, Gayol S, Tournoud C, Zaehringer M, Jaeger A, Sauder P: Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema (ACPE). Intensive Care Med 1999, 25: 21-28. 10.1007/s001340050782CrossRefPubMed
Metadata
Title
A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis
Authors
Kwok M Ho
Karen Wong
Publication date
01-04-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4861

Other articles of this Issue 2/2006

Critical Care 2/2006 Go to the issue

Letter

Implementing the International Liaison Committee on Resuscitation guidelines on hypothermia after cardiac arrest. The German experience: still a long way to go?

Letter

Erroneous measurement of haemodynamic parameters by PiCCO™ monitor in a critically ill patient with renal replacement therapy: a case report

Commentary

Strong ion difference in urine: new perspectives in acid-base assessment

Research

Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study

Research

Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study

Commentary

Levels of protein C and activated protein C: what do they mean?