Continuous Positive Airway Pressure Versus Bilevel Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Randomized Multicenter Trial

• Published in: Annals of emergency medicine 2007-12, Vol.50 (6), p.666-675.e1
• Main Authors: Moritz, Fabienne, MD, PhD, Brousse, Benoit, MD, Gellée, Bruno, MD, Chajara, Abdesslam, ScD, L'Her, Erwan, MD, PhD, Hellot, Marie-France, ScD, Bénichou, Jacques, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Continuous Positive Airway Pressure - instrumentation; Continuous Positive Airway Pressure - methods; Emergency; Emergency and intensive respiratory care; Emergency Service, Hospital - statistics & numerical data; Female; France - epidemiology; Hospital Mortality; Humans; Intensive care medicine; Laryngeal Masks; Length of Stay; Male; Medical sciences; Pneumology; Prospective Studies; Pulmonary Edema - mortality; Pulmonary Edema - therapy; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Treatment Outcome
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2007.06.488

Study objective Patients with acute cardiogenic pulmonary edema may develop respiratory failure. Noninvasive respiratory support should be initiated rapidly to avoid tracheal intubation. The aim of this study is to compare the efficacy of continuous positive airway pressure (CPAP) delivered by the Boussignac CPAP device and bilevel positive airway pressure (bilevel PAP) in patients with acute respiratory failure caused by acute cardiogenic pulmonary edema. Methods This prospective multicenter randomized study was conducted in 3 emergency departments. Patients were assigned to Boussignac CPAP through a facemask or to bilevel PAP, in addition to standard therapy. The main outcome was a combined criterion (tracheal intubation, death, or acute myocardial infarction). Complications, durations of ventilation, and hospitalization were also assessed. Results After 1 hour of ventilation and at the end of the ventilation period, clinical parameters of respiratory distress and blood gas exchange significantly improved in each treatment arm. No significant differences were observed between the Boussignac CPAP and bilevel PAP arms for the combined criterion (5% versus 12%, respectively; odds ratio [OR] 0.4; 95% confidence interval [CI] 0.0 to 1.9) and also for severe complications (9% versus 6%; OR 1.5; 95% CI 0.3 to 9.9), duration of ventilation (median for both groups 2 hours; interquartile range [IQR] 1.2 to 3.0 hours), duration of hospitalization (CPAP 8.5 [IQR 6 to 14] days; bilevel PAP 10 [IQR 7 to 16] days), or intrahospital mortality (8% versus 14%; OR 1.8 [IQR 0.4 to 8.8]). Similar results were obtained among hypercapnic patients (PaCO2 >45 mm Hg). Whatever the ventilation support used, the combined criterion and severe complications were more frequently observed among hypercapnic patients. Conclusion Both Boussignac CPAP and bilevel PAP appeared effective in rapidly improving respiratory distress even in hypercapnic patients, but they were not different in terms of patient outcome.