Noninvasive ventilation in acute cardiogenic pulmonary edema.

Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J

This large multicenter, randomized, controlled trial set out to establish whether; noninvasive ventilation (continuous positive airway pressure (CPAP) or noninvasive intermittent positive-pressure ventilation (NIPPV)) reduces mortality and if there are important differences in outcome associated with the method of treatment, in a group of patients with acute cardiogenic pulmonary oedema.

Their findings included no significant difference in; 7-day mortality between patients receiving standard oxygen therapy and those undergoing noninvasive ventilation, or in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation. Noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea, heart rate, acidosis and hypercapnia. There were no treatment-related adverse events.

New England Journal of Medicine 2008; 359: 142-51.

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