Review ArticleNoninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Meta-Analysis of Randomized Controlled Trials
Section snippets
Inclusion and Exclusion Criteria
The studies had to meet the following inclusion criteria: be randomized and controlled, compare CPAP or NIPPV with either standard therapy (ST) or each other, include adult patients with ACPE, and have the outcome data available. One study8 comparing CPAP with proportional assist ventilation was also included, because this ventilatory modality has several features of NIPPV. Only published studies were included.
Search Strategy
We conducted an electronic search to retrieve from Embase, Medline, Cinahl, Dare,
Results
We identified 524 reports of studies, of which 118 were duplicates, leaving 406 potentially relevant reports. After title and abstract assessment, 364 reports were excluded because it was evident that the publications were from nonrandomized studies or did not include either the target population or the intervention of interest. We retrieved 42 full text reports for further evaluation, and 8 were finally excluded7 (Fig. 1; also see Supplemental References, available with the online version of
Discussion
The present systematic review suggests that either CPAP or NIPPV reduce in-hospital mortality among ACPE patients. While confirming data suggesting that either form of NIV reduces the need of endotracheal intubation, this meta-analysis provides new data on mortality and shows that NIPPV is associated with more rapid and better oxygenation than CPAP.
This analysis extends earlier findings on the role of NIV among ACPE patients. The present study is the first to demonstrate that NIPPV is
Disclosures
None.
References (50)
- et al.
Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database
J Am Coll Cardiol
(2006) - et al.
Effect of noninvasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis
Lancet
(2006) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) A prospective, randomized trial of BiPAP in severe acute congestive heart failure
J Emerg Med
(2001)- et al.
Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Short-term results and long-term follow-up
Chest
(1995) - et al.
Noninvasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial
Lancet
(2000) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema
Am J Cardiol
(1985) - 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) - et al.
Continuous positive airway pressure vs. pressure support ventilation in acute cardiogenic pulmonary edema: a randomized trial
J Emerg Med
(2010)
Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology
Eur Heart J
Efficacy and safety of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema—a systematic review and meta-analysis
Crit Care
Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema
Ann Intern Med
Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema
Crit Care Med
Continuous positive airway pressure vs. proportional assist ventilation for noninvasive ventilation in acute cardiogenic pulmonary edema
Intensive Care Med
Boussignac continuous positive airway pressure device in the emergency care of acute cardiogenic pulmonary oedema: a randomized pilot study
Eur J Emerg Med
Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema; effects on plasma brain natriuretic peptide concentrations
Eur Heart J
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
Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask
N Engl J Med
Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema
Crit Care Med
Noninvasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: a multicenter randomized study in the emergency department
Intensive Care Med
Bias in meta-analysis detected by a simple, graphical test
BMJ
Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses
BMJ
Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial
Am J Respir Crit Care Med
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