Abstract
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 (O<sup>2</sup>) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO<sup>2</sup>, PaO<sup>2</sup>, SaO<sup>2</sup>, pH, and HCO<sup>3</sup>), 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 PaCO<sup>2</sup>, PaO<sup>2</sup>, SaO<sup>2</sup> and vital signs were observed immediately after CPAP and Bi-PAP when compared to O<sup>2</sup> therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO<sup>2</sup>, SaO<sup>2</sup>, 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.
Highlights
Acute cardiogenic pulmonary edema (ACPE) is one of the most common conditions presenting to the emergency department
Mild nasal bridge rednish was observed in 10 patients, 6 in continuous positive airway pressure (CPAP) group and 4 in Bi-PAP group
This study is the first single blinded, randomized trial designed to compare the potential effectiveness of Bi-PAP, CPAP and standard oxygen therapy on blood gases and physiological parameters in patients with ACPE at the emergency department in Egypt
Summary
Acute cardiogenic pulmonary edema (ACPE) is one of the most common conditions presenting to the emergency department. It is associated with higher rate of death, especially when it is coupled with acute myocardial infarction [1,2,3]. Standardized medical treatment with oxygen therapy, diuretics, and vasodilators could improve the symptom of most of the patients with ACPE. Over the past three decades, application of noninvasive ventilation (NIV) either with continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (BiPAP) has been used with the standardized medical treatment as an effective therapeutic approach to treat ACPE [5,6,7,8,9,10].
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