Intervention Review

Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema

  1. Flávia MR Vital2,
  2. Humberto Saconato3,
  3. Magdaline T Ladeira 4,
  4. Ayan Sen5,
  5. Claire A Hawkes6,
  6. Bernardo Soares7,
  7. Karen E. A. Burns8,
  8. Álvaro N Atallah1,*

Editorial Group: Cochrane Heart Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 28 APR 2005

DOI: 10.1002/14651858.CD005351.pub2

Database Title

Additional Information

How to Cite

Vital FMR, Saconato H, Ladeira MT, Sen A, Hawkes CA, Soares B, Burns KEA, Atallah ÁN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005351. DOI: 10.1002/14651858.CD005351.pub2.

Author Information

  1. 1

    Universidade Federal de São Paulo / Escola Paulista de Medicina, Director of Brazilian Cochrane Centre, São Paulo, SP, Brazil

  2. 2

    Muriaé Cancer Hospital , Muriaé, MG, Brazil

  3. 3

    Federal University of Rio Grande do norte, Department of Medicine, Sao Paulo, Vila Clementino, Brazil

  4. 4

    Universidade Federal de São Paulo/Escola Paulista de Medicina, Internal and Therapeutic Medicine, Minas Gerais, Brazil

  5. 5

    University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA

  6. 6

    School of Health and Social Studies, Royal College of Nursing Research Institute, Coventry, UK

  7. 7

    Brazilian Cochrane Centre, São Paulo, SP, Brazil

  8. 8

    St Michael's Hospital, Critical Care Medicine, Toronto, Ontario, Canada

*Álvaro N Atallah, Director of Brazilian Cochrane Centre, Universidade Federal de São Paulo / Escola Paulista de Medicina, Rua Pedro de Toledo 598 , Vila Clementino, São Paulo, SP, CEP 04039-001, Brazil. atallahmbe@uol.com.br. cochrane.dmed@epm.br.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUL 2008

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (60K)Standard (594K)Full (1004K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Non-invasive positivepressure ventilation (NPPV) has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing.

Objectives

To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary edema.

Search methods

We undertook a comprehensive search of the following databases in April 2005: CENTRAL, MEDLINE, EMBASE, CINAHL, DARE and LILACS. We also reviewed reference lists of included studies and contacted experts, equipment manufacturers, and the Cochrane Heart Group. We did not apply language restrictions.

Selection criteria

We selected blinded or unblinded randomized or quasi-randomized clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and where NPPV (continuous positive airway pressure (CPAP)) and/or bilevel NPPV plus standard medical care was compared with standard medical care alone.

Data collection and analysis

Two authors independently selected articles and abstracted data using a standardized data collection form. We evaluated study quality with emphasis on allocation concealment, adherence to the intention-to-treat principle and losses to follow-up.

Main results

We included 21 studies involving 1,071 participants. Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83) with numbers needed to treat of 13 and 8, respectively. We found no difference in hospital length of stay with NPPV, however, intensive care unit stay was reduced by 1 day (WMD -1.07 days, 95% CI -1.60 to -0.53). Compared to standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.82, 95% CI 0.09 to 7.54) its application.

Authors' conclusions

NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Non-invasive positive pressure ventilation for cardiogenic pulmonary edema

Acute heart failure is a problem of high incidence in general population and may culminate in acute cardiogenic pulmonary edema (ACPE). This review aimed to determine the effectiveness and safety of non-invasive positive pressure ventilation (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care, compared with standard medical care alone in adults with ACPE. We included 21 studies involving 1,071 participants. Results from randomized controlled trials demonstrate that the use of NPPV, especially CPAP, reduces mortality, endotracheal intubation rate and intensive care unit length of stay without increasing the risk of heart attack during or after treatment.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以非侵入性正壓呼吸器 (NPPV) [連續式正壓呼吸器 (CPAP) 或雙程度正壓呼吸器 (BiNPPV)] 針對心因性肺水腫的治療

非侵入性正壓呼吸器已經廣泛地使用於緩解心因性肺水腫病人的呼吸窘迫症狀，它可預防肺泡塌陷且改善肺泡內液體的再分布，進而改善肺部的順應性與降低呼吸的壓力。

目標

測定非侵入性正壓呼吸器在治療成人心因性肺水腫的療效與安全性。

搜尋策略

在2005年4月份蒐集從CENTRAL, MEDLINE, EMBASE, CINAHL, DARE 和 LILACS等資料庫中的研究，也回顧了各研究中所列出的參考資料、相關研究專家、機構與考科藍心臟學團隊；收集的資料並沒有語言限制。

選擇標準

我們選擇單盲或非盲的隨機或半隨機臨床試驗，針對急性心因性水腫與慢性心因性水腫合併急性發作，比較合併使用 非侵入性正壓呼吸器 (包含連續式正壓呼吸器或雙程度正壓呼吸器) 及標準藥物治療與單純使用標準藥物之療效。

資料收集與分析

兩位作者獨立的使用標準化流程分開蒐集文章與摘要，評估研究的品質，強調在隨機分派是否適當 (allocation concealment)、對於治療方式的遵從度原則、與失去後續追蹤等之評估。

主要結論

我們納入21 個研究，包括1071 個研究個案，比較單純標準藥物治療，非侵入性正壓呼吸器可以顯著降低住院死亡率 (RR 0.6, 95% CI 0.45 to 0.84) 與氣管內管插管率 (RR 0.53, 95% CI 0.34 to 0.83)，各別的必須治療數 (numbers needed to treat, NNT) 為13 與 8。我們發現在加護病房住院天數可以減少一天 (WMD −1.07 days, 95% CI −1.60 to −0.53)，但使用非侵入性正壓呼吸器對住院天數並沒有差異。與標準藥物治療比較時，使用非侵入性正壓呼吸器時 (RR 1.24, 95% CI 0.79 to 1.95) 或使用非侵入性正壓呼吸器後 (RR 0.82, 95% CI 0.09 to 7.54) 並沒有顯著的增加急性心肌梗塞發生率。

作者結論

非侵入性正壓呼吸器特別是連續性正壓呼吸器，合併標準藥物治療對於成人心因性肺水腫的治療是有效而且安全的。

翻譯人

本摘要由臺北榮民總醫院吳東翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

急性心臟衰竭在一般族群中是高發生率的問題，而且可能造成急性心因性肺水腫，本回顧文章目的在決定急性心因性肺水腫的成人，使用非侵入性正壓呼吸器 (包含連續性正壓呼吸器與雙程度非侵入性正壓呼吸器) 合併標準藥物治療與單獨標準藥物治療的療效與安全性。我們蒐集了21 個研究，包括1071研究個案。從隨機對照研究中的結果，顯示使用非侵入性正壓呼吸器特別是連續性正壓呼吸器，合併標準藥物治療對於成人心因性肺水腫的治療是可以降低死亡率、減少氣管內管插管率、與加護病房住院天數；使用非侵入性正壓呼吸器時或使用非侵入性正壓呼吸器後並不會增加急性心肌梗塞的發生率。

View Full Article (HTML) Summary (60K)Standard (594K)Full (1004K)