A Cochrane review [Abstract] 1 included 24 studies with a total of 2 664 adult participants with respiratory distress due to acute cardiogenic pulmonary oedema (ACPE), not requiring immediate mechanical ventilation. Non-invasive positive pressure ventilation (NPPV), including continuous positive airway pressure (CPAP) and bilevel NPPV, was compared with standard medical care. NPPV significantly reduced hospital mortality and endotracheal intubation with numbers needed to treat of 17 (12 to 32) and 13 (11 to 18), respectively (table T1). There was no difference in hospital length of stay between NPPV and standard care, and adverse events were generally similar between NPPV and standard medical care groups.
| Outcome | Relative effect (95% CI) | Assumed risk - Usual care | Corresponding risk - NPPV* | Participants (studies) |
|---|---|---|---|---|
| * NPPV = non-invasive positive pressure ventilation (CPAP and bilevel NPPV); ** statistical heterogeneity, I2 =55% | ||||
| Hospital mortality | RR 0.65 (0.51 to 0.82) | 176 per 1000 | 114 per 1000 (90 to 144) | 2 484 (21 studies) |
| Endotracheal intubation rate | RR 0.49 (0.38 to 0.62) | 154 per 1000 | 75 per 1000 (58 to 95) | 2 449 (20 studies) |
| Acute myocardial infarction | RR 1.03 (0.91 to 1.16) | 421 per 1000 | 433 per 1000 (383 to 488) | 1 313 (5 studies) |
| Hospital length of stay | The mean hospital length of stay was 9.65 days | MD 0.31 days lower(1.23 lower to 0.61 higher)** | 1 714 (11 studies) | |
Subgroup analysis by NPPV type identified no significant difference between CPAP and bilevel NPPV subgroups in hospital mortality or endotrachel intubation rates. Both NPPV forms reduced hospital mortality and endotracheal intubation rates compared to standard medical care (table T2 and T3).
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