Positive pressure airway support for cardiogenic pulmonary oedema

Summary

A Cochrane review «Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema»1 «Berbenetz N, Wang Y, Brown J et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2019;(4):CD005351. »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 «Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema compared with standard medical care.»1). 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.

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 «Hospital mortality»2 and «Endotracheal intubation rate»3).