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Evidence summaries

Cpap and Bipap Non-Invasive Ventilation in Patients with Acute Cardiogenic Pulmonary Oedema

Bi-level positive airway pressure (BiPAP) noninvasive ventilation may not offer any substantial clinical advantage over continuous positive airway pressure (CPAP) in patients with acute cardiogenic pulmonary oedema, regardless of whether BiPAP support is titrated, or whether patients have marked hypercapnia. Level of evidence: "C"

A systematic review 1 including 7 studies with a total of 290 subjects was abstracted in DARE. Hospital mortality (RR 0.76, 95% CI 0.32 to 1.78) and risk for requiring invasive ventilation (RR 0.80, 95% CI 0.33 to 1.94) were not significantly different in patients treated with BiPAP compared to those treated with CPAP. Stratifying studies that used either fixed or titrated pressure during BiPAP treatment and studies involving patients with or without hypercapnia did not change the results. The duration of noninvasive ventilation required until the pulmonary oedema resolved and length of hospital stay were also not significantly different between the two groups. Based on the limited data available, there was an insignificant trend toward an increase in new onset acute myocardial infarction in patients treated with BiPAP (RR 2.10, 95% CI 0.91 to 4.84; 4 studies, n=167).

Comment: The quality of evidence is downgraded by study quality (lack of blinding) and by imprecise results (limited study size for each comparison).

    References

    • Ho KM, Wong K. A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Crit Care. 2006;10(2):R49. [DARE]

Primary/Secondary Keywords