The role of noninvasive ventilation in acute cardiogenic pulmonary edema

Abstract

A total of 1069 patients (mean [±SD] age, 77.7±9.7 years; female sex, 56.9%) were assigned to standard oxygen therapy (367 patients), CPAP (346 patients), or NIPPV (356 patients). There was no signifi cant diff erence 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 signifi cant diff erence 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 dyspnea (treatment diff erence, 0.7 on a visual-analogue scale ranging from 1 to 10; 95% confi dence interval [CI], 0.2 to 1.3; P=0.008), heart rate (treatment diff erence, 4 beats per minute; 95% CI, 1 to 6; P=0.004), acidosis (treatment diff erence, pH 0.03; 95% CI, 0.02 to 0.04; P<0.001), and hypercapnia (treatment diff erence, 0.7 kPa [5.2 mm Hg]; 95% CI, 0.4 to 0.9; P<0.001). There were no treatment-related adverse events.