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Noninvasive Ventilation Reduces Mortality in Acute Pulmonary Edema

Both continuous positive airway pressure and bilevel noninvasive pressure support ventilation are effective.

Noninvasive ventilation (NIV) has been shown to decrease mortality in patients with chronic obstructive pulmonary disease. In a meta-analysis, these authors assessed the effects of NIV in the management of patients with acute pulmonary edema.

The authors searched for randomized controlled trials and systematic reviews published from January 1988 through October 2005 that compared NIV to conventional oxygen therapy and that directly compared the two types of NIV: continuous positive airway pressure (CPAP) and bilevel noninvasive pressure support ventilation (NIPSV). Fifteen trials involving 727 patients met the study criteria.

Overall, NIV significantly reduced mortality compared with conventional therapy (risk ratio, 0.55); CPAP significantly reduced mortality (RR, 0.53) but NIPSV did not (RR, 0.60). Both CPAP and NIPSV significantly reduced the need to intubate compared with conventional therapy (RR, 0.40 and 0.48, respectively). In direct comparisons of CPAP and NIPSV, there were no significant differences in mortality or intubation rates.

Comment: Acute pulmonary edema is the second most prevalent indication for NIV. This study demonstrates that both CPAP and NIPSV reduce mortality and the need for intubation in patients with this condition. However, CPAP is technically simpler to institute and does not require a ventilator.

— John A. Marx, MD, FAAEM, FACEP

Published in Journal Watch Emergency Medicine March 14, 2006

Citation(s):

Masip J et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: Systematic review and meta-analysis. JAMA 2005 Dec 28; 294:3124-30.

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