Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial
Clinical Medicine Research
Volume 4, Issue 6, November 2015, Pages: 221-228
Received: Dec. 12, 2015;
Accepted: Dec. 27, 2015;
Published: Jan. 8, 2016
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Basant Hamdy El-Refay, Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Rehab Farrag Gwada, Department of Physical Therapy, National Heart Institute, Giza, Egypt
Bassem S. Ibrahim, Heart Failure Unit, National Heart Institute, Giza, Egypt
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 (O2) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO2, PaO2, SaO2, pH, and HCO3), 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 PaCO2, PaO2, SaO2 and vital signs were observed immediately after CPAP and Bi-PAP when compared to O2 therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO2, SaO2, 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.
Basant Hamdy El-Refay,
Rehab Farrag Gwada,
Bassem S. Ibrahim,
Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial, Clinical Medicine Research.
Vol. 4, No. 6,
2015, pp. 221-228.
Felker GM, Adams KF Jr, Konstam MA, et al. The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J 2003; 145: Suppl: S18-S25.
Girou E, Brun-Buisson C, Taillé S, et al. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 2003; 290: 2985-91.
Stevenson R, Ranjadayalan K, Wilkinson P, et al. Short and long term prognosis of acute myocardial infarction since introduction of thrombolysis. BMJ 1993; 307: 349-53. [Erratum, BMJ 1993; 307: 909.]
Pingleton SK: Complication of acute respiratory failure. Am Rev Respir Dis 1988, 173: 1463-1493.
Baratz DM, Westbrook PR, Shah PK, et al. Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure. Chest 1992; 102: 1397-401.
Lenique F, Habis M, Lofaso F, et al. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 1997; 155: 500-5.
Naughton MT, Rahman MA, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 1995; 91: 1725-31.
Park M, Lorenzi-Filho G, Feltrim MI, et al. 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: 221–30.
Park M, Sangean MC, Volpe MS, et al. Randomized, Prospective Trial of Oxygen Therapy, Continuous Positive Airway Pressure, and Bi-level Positive by Face Mask in Acute Cardiogenic Pulmonary Edema. Crti Care Med. 2004; 32: 2407-15.
Bellone A, Monari A, Cortellaro F, et al. "Myocardial Infarction Rate in Acute Pulmonary Edema: Non-Invasive Pressure Support Ventilation Versus Continuous Positive Airway Pressure" Intensive Care Med. 2004; 32: 1860-1865.
Moritz F, Brousse B, Gelle´e B, et al. Continuous Positive Airway Pressure versus Bi-level Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: a Randomized Multicenter Trial" Ann Emerg Med. 2007; 50 (6): 666-675.
L'Her E, Duquesne F, Girou E, et al. Noninvasive Continuous Positive Airway Pressure in elderly Cardiogenic pulmonary Edema Patients. Intensive Care Med. 2004; 30: 882-888.
Crane SD, Ellitto MW, Gilligan P, et al. Randomized Controlled Comparison of Continuous Positive Airway pressure, Bi-level Non-Invasive Ventilation, and standard treatment in Emergency Department patients with Acute Cardiogenic Pulmonary Edema. Emerg Med J. 2004; 21: 155-161.
Mehta S., Jay GD., Woolard RH., et al. Randomized, Prospective Trial of Bi-level Versus Continuous Positive Airway Pressure in Acute Pulmonary Edema. Crit Care Med. 1997; 25: 620-628.
Bersten AD, Holt AW, Vedig AE, et al. Treatment of Sever Cardiopulmonary Edema Continuous Positive Airway Pressure Delivered by Face Mask. N Engl J Med. 1991; 325: 1825-30.
Lin M, yang Y, Chiang HT, et al. Reappraisal of Continuous Positive Airway Pressure Therapy in Acute Cardiogenic Pulmonary Edema. Chest. 1995; 107: 1379-1386.
Chadda K, Annane D, Hart N, et al. Cardiac and Respiratory Effects of Continuous Positive Airway Pressure and Noninvasive Ventilation in Acute Cardiopulmonary Edema. Crit Care Med. 2002; 30: 2457-2461.
Nava S, Carbone G, Dibattista N, et al. Noninvasive Ventilation in Cardiogenic Pulmonary Edema: a Multicenter Randomized Trial. Am J Respir Crit Care Med. 2003; 168: 1432-1437.
Lin M, Chiang H. The efﬁcacy of early continuous positive airway pressure therapy in patients with acute cardiogenic pulmonary edema. Journal of the Formosan Medical Association 1991; 90 (8): 736–43.
Nouira S, Boukef R, Bouida W, et al. Noninvasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: a multicenter randomized study in the emergency department. Intensive Care Med 2011; 37: 249–56.
Masip J, Betbese AJ, Paez J, et al. Non-Invasive Pressure Support Ventilation Versus Conventional Oxygen Therapy in Acute Cardiogenic Pulmonary Oedema: A Randomized Trial. Lance. 2000; 356: 2126-32.
Ferrari G, Olliveri F, De Filippi G, et al. Noninvasive Positive Airway Pressure and Risk of Myocardial Infarction in Acute Cardiogenic Pulmonary Edema: Continuous Positive Airway Pressure vs Noninvasive Positive Pressure Ventilation. Chest. 2007; 132 (6): 1804-1809.
Levitt MA. A Prospective, Randomized Trial of Bi-PAP in Severe Acute Congestive Heart Failure. J Emerg Med. 2001; 21(4): 363-369.
Gray A, Goodscre S, Newby DE, et al. 3COP Trailists. Noninvasive Ventilation in Acute Cardiogneic Pulmonary Edema. N Engl J Med. 2008; 359 (2): 142-151.
Ferrer M, Esquinas AN, Leon M, et al. Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure: a Randomized Clinical Trial. Am J Respir Crit Care Med. 2003; 168 (12): 1438-1444.
Hasan BE, Elwela GM, Bondok RH, et al., Noninvasive Bi-PAP Ventilation For acute cardiogenic pulmonary edema. Ain Shamis journal of anastheiology. 2009; 2: 29-38.
Ferrari G, Milan A, Groff P, et al. Continuous Positive Airway Pressure vs. Pressure Support Ventilation in Acute Cardiogenic Pulmonary Edema: A randomized Trial. J Emerg Med. 2009; 70: 042.
Bellone A, Vettorello M, Monari A, et al. Noninvasive Pressure Support Ventilation vs. Continuous Positive Airway Pressure in Acute Hypercapnic Pulmonary Edema. Intensive Care Med. 2005; 31 (6): 807-811.
Bristow MR, David Port J, and Kelly RA. Treatment of heart failure-Pharmacological methods. In: Braunwald E, editor. A Textbook of Cardiovacular Medicine. 6th ed. Philadelphia 2001. P682-689.
Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstruction lung disease. N Engl J Med 1995, 333: 817-22.
Kelly CA, Newb DE, Mc-Donagh TA, et al. Randomized Controlled Trial of Continuous Positive Airway Pressure and Standard oxygen Therapy in Acute Pulmonary Edema. Eur Heart J. 2002; 23: 1379-1386.
Peter JV, Moran JG, Graham P, et al. Effect of Nom –Invasive Positive Pressure Ventilation (NIPPV) on Mortality in Patients with Acute Cardiogenic Pulmonary Edema: A Meta-Analysis. Lancet. 2006; 367: 1155-63.
Masip J, Roque M, Sanchez B, Fernoridez R, et al. Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: Systemic Review and Met-Analysis. JAMA. 2005; 294: 3124-30.
Cross AM, Cameron P, Kierce M, et al. Non-invasive Ventilation in Acute Respiratory Failure: a Randomized Comparison of Continuous Positive Airway Pressure and Bi-level Positive Airway Pressure. Emerg Med J. 2003; 20 (6): 531-534.
Liesching T, Nelson DL, Comier KL, et al. Randomized trial of Bilevel versus continuous positive Airway Pressuer for Acute Pulmonary Edema. The Journal of Emergency Medicine. 2014; 46 (1): 130-140.
Hui L, Chunlin H, Jinming X, et al. A comparison of bi-level and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary edema: A Meta-Analysis. American Journal of Emergency Medicine. 2013; 31: 1322–1327
Garrote JI, Aylagas D, Gutierrez JM, et al. Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Save Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study. amj. 2015; 34 (4): 218-222.
Ho KM, and Wong K. A Comparison of Continuous and Bi-level Positive Non-Invasive Ventilation in Patients with Acute Cardiogenic Pulmonary Edema: A Meta-Analysis. Crit Care. 2006; 10 (2): R49.