Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

摘要: ContextIn patients with acute cardiogenic pulmonary edema noninvasive ventilation may reduce intubation rate, but the impact on mortality and superiority of one technique over another have not been clearly established.ObjectiveTo systematically review quantitatively synthesize short-term effect major clinical outcomes.Data SourcesMEDLINE EMBASE (from inception to October 2005) Cochrane databases (library issue 4, were searched identify relevant randomized controlled trials systematic reviews published from January 1, 1988, 31, 2005.Study Selection Data ExtractionIncluded all parallel studies comparing conventional oxygen therapy in edema. Comparisons different techniques, either continuous positive airway pressure (CPAP) or bilevel support (NIPSV), also included.Data SynthesisFifteen selected. Overall, significantly reduced rate by nearly 45% compared (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.40-0.78; P = .72 for heterogeneity). The results significant CPAP (RR, 0.53; CI, 0.35-0.81; P = .44 heterogeneity) NIPSV 0.60; 0.34-1.05; P = .76 heterogeneity), although there fewer latter. Both modalities showed a decrease “need intubate” therapy: 0.40; 0.27-0.58; P = .21 0.48; 0.30-0.76; P = .24 together 0.43; 0.32-0.57; P = .20 There no differences rates analysis 2 techniques.ConclusionsNoninvasive reduces need Although level evidence is higher CPAP, are outcomes when vs NIPSV.