OBJECTIVE:Continuous positive airway pressure (CPAP) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. However, we hypothesized that bilevel noninvasive positive-pressure ventilation (NPPV), which combines both inspiratory pressure support and positive expiratory pressure, would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP. DESIGN: Randomized crossover study. SETTING: Critical care unit, Raymond Poincaré Hospital. PATIENTS: Six consecutive patients with acute cardiogenic pulmonary edema. INTERVENTIONS: Patients were sequentially treated with 5 cm H2O CPAP, 10 cm H2O CPAP, and NPPV in a random order. MEASUREMENTS AND MAIN RESULTS:Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence. NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline (p <.05). There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP. NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index. CONCLUSIONS: This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema. In addition, NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload, which suggests an improvement in cardiac performance.
RCT Entities:
OBJECTIVE: Continuous positive airway pressure (CPAP) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. However, we hypothesized that bilevel noninvasive positive-pressure ventilation (NPPV), which combines both inspiratory pressure support and positive expiratory pressure, would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP. DESIGN: Randomized crossover study. SETTING: Critical care unit, Raymond Poincaré Hospital. PATIENTS: Six consecutive patients with acute cardiogenic pulmonary edema. INTERVENTIONS:Patients were sequentially treated with 5 cm H2O CPAP, 10 cm H2O CPAP, and NPPV in a random order. MEASUREMENTS AND MAIN RESULTS: Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence. NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline (p <.05). There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP. NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index. CONCLUSIONS: This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema. In addition, NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload, which suggests an improvement in cardiac performance.
Authors: Sean P Keenan; Tasnim Sinuff; Karen E A Burns; John Muscedere; Jim Kutsogiannis; Sangeeta Mehta; Deborah J Cook; Najib Ayas; Neill K J Adhikari; Lori Hand; Damon C Scales; Rose Pagnotta; Lynda Lazosky; Graeme Rocker; Sandra Dial; Kevin Laupland; Kevin Sanders; Peter Dodek Journal: CMAJ Date: 2011-02-14 Impact factor: 8.262
Authors: Juan Mayordomo-Colunga; Alberto Medina; Corsino Rey; Juan José Díaz; Andrés Concha; Marta Los Arcos; Sergio Menéndez Journal: Intensive Care Med Date: 2008-11-04 Impact factor: 17.440
Authors: S U C Sankatsing; W E J J Hanselaar; R P van Steenwijk; J A P van der Sloot; E Broekhuis; W E M Kok Journal: Neth Heart J Date: 2008-09 Impact factor: 2.380