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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.CC

Abstract

INTRODUCTION

We conducted the present study to investigate the potential beneficial and adverse effects of continuous positive airway pressure (CPAP) compared with bi-level positive airway pressure (BiPAP) noninvasive ventilation in patients with cardiogenic pulmonary oedema.

METHOD

We included randomized controlled studies comparing CPAP and BiPAP treatment in patients with cardiogenic pulmonary oedema from the Cochrane Controlled Trials Register (2005 issue 3), and EMBASE and MEDLINE databases (1966 to 1 December 2005), without language restriction. Two reviewers reviewed the quality of the studies and independently performed data extraction.

RESULTS

Seven randomized controlled studies, including a total of 290 patients with cardiogenic pulmonary oedema, were considered. The hospital mortality (relative risk [RR] 0.76, 95% confidence interval [CI] 0.32-1.78; P = 0.52; I2 = 0%) and risk for requiring invasive ventilation (RR 0.80, 95% CI 0.33-1.94; P = 0.62; I2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. 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 (weighted mean difference [WMD] in hours = 3.65, 95% CI -12.12 to +19.43; P = 0.65, I2 = 0%) and length of hospital stay (WMD in days = -0.04, 95% CI -2.57 to +2.48; P = 0.97, I2 = 0%) 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 0.91-4.84; P = 0.08; I2 = 25.3%).

CONCLUSION

BiPAP does not offer any significant clinical benefits over CPAP in patients with acute cardiogenic pulmonary oedema. Until a large randomized controlled trial shows significant clinical benefit and cost-effectiveness of BiPAP versus CPAP in patients with acute cardiogenic pulmonary oedema, the choice of modality will depend mainly on the equipment available.

Links

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Authors+Show Affiliations

Ho KM
Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia. kwok.ho@health.wa.gov.au.
Wong K
No affiliation info available

MeSH

Acute DiseaseContinuous Positive Airway PressureHumansPositive-Pressure RespirationPulmonary Edema

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16569254

Citation

Ho, Kwok M., and Karen Wong. "A Comparison of Continuous and Bi-level Positive Airway Pressure Non-invasive Ventilation in Patients With Acute Cardiogenic Pulmonary Oedema: a Meta-analysis." Critical Care (London, England), vol. 10, no. 2, 2006, pp. R49.
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.
Ho, K. M., & Wong, K. (2006). A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Critical Care (London, England), 10(2), R49.
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. PubMed PMID: 16569254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. AU - Ho,Kwok M, AU - Wong,Karen, PY - 2006/02/03/received PY - 2006/02/21/revised PY - 2006/02/22/accepted PY - 2006/3/30/pubmed PY - 2006/12/9/medline PY - 2006/3/30/entrez SP - R49 EP - R49 JF - Critical care (London, England) JO - Crit Care VL - 10 IS - 2 N2 - INTRODUCTION: We conducted the present study to investigate the potential beneficial and adverse effects of continuous positive airway pressure (CPAP) compared with bi-level positive airway pressure (BiPAP) noninvasive ventilation in patients with cardiogenic pulmonary oedema. METHOD: We included randomized controlled studies comparing CPAP and BiPAP treatment in patients with cardiogenic pulmonary oedema from the Cochrane Controlled Trials Register (2005 issue 3), and EMBASE and MEDLINE databases (1966 to 1 December 2005), without language restriction. Two reviewers reviewed the quality of the studies and independently performed data extraction. RESULTS: Seven randomized controlled studies, including a total of 290 patients with cardiogenic pulmonary oedema, were considered. The hospital mortality (relative risk [RR] 0.76, 95% confidence interval [CI] 0.32-1.78; P = 0.52; I2 = 0%) and risk for requiring invasive ventilation (RR 0.80, 95% CI 0.33-1.94; P = 0.62; I2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. 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 (weighted mean difference [WMD] in hours = 3.65, 95% CI -12.12 to +19.43; P = 0.65, I2 = 0%) and length of hospital stay (WMD in days = -0.04, 95% CI -2.57 to +2.48; P = 0.97, I2 = 0%) 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 0.91-4.84; P = 0.08; I2 = 25.3%). CONCLUSION: BiPAP does not offer any significant clinical benefits over CPAP in patients with acute cardiogenic pulmonary oedema. Until a large randomized controlled trial shows significant clinical benefit and cost-effectiveness of BiPAP versus CPAP in patients with acute cardiogenic pulmonary oedema, the choice of modality will depend mainly on the equipment available. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/16569254/A_comparison_of_continuous_and_bi_level_positive_airway_pressure_non_invasive_ventilation_in_patients_with_acute_cardiogenic_pulmonary_oedema:_a_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -