Thursday August 7, 2008
Does Non Invasive ventilation improve short term mortality in patients with acute cardiogenic pulmonary edema??


In a study published in NEJM by Alasdair gray they studied the above issue. A total of 1069 patients were assigned to

• Standard oxygen therapy (367 patients),
• CPAP (346 patients), or
• NIPPV (356 patients)

Standard oxygen therapy, CPAP (5 to 15 cm of water), or NIPPV (inspiratory pressure, 8 to 20 cm of water; expiratory pressure, 4 to 10 cm of water)


Results:

• There was no significant difference in 7-day mortality between patients receiving standard oxygen therapy (9.8%) and those undergoing noninvasive ventilation (9.5%, P=0.87).
• There was no significant difference in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation (11.7% for CPAP and 11.1% for NIPPV, P=0.81).
• As compared with standard oxygen therapy, noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspne , heart rate, acidosis and hypercapnia.
• There were no treatment-related adverse events

Conclusions: In patients with acute cardiogenic pulmonary edema, noninvasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance than does standard oxygen therapy but has no effect on short-term mortality



Reference: click to get abstract

Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J. Noninvasive ventilation in acute cardiogenic pulmonary edema. NEJM July 10th 2008; 359: 142-151