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Published ahead of print on September 4, 2003, doi:10.1164/rccm.200211-1270OC
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American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 1432-1437, (2003)
© 2003 American Thoracic Society

Noninvasive Ventilation in Cardiogenic Pulmonary Edema

A Multicenter Randomized Trial

Stefano Nava, Giorgio Carbone, Nicola DiBattista, Andrea Bellone, Paola Baiardi, Roberto Cosentini, Mauro Marenco, Fabrizio Giostra, Guido Borasi and Paolo Groff

Respiratory Intensive Care Unit, Istituto Scientifico di Pavia, IRCCS Fondazione S. Maugeri, Pavia; Emergency Departments of Gradenigo Hospital, Turin; S. Orsola Hospital, Bologna; Correggio Hospital, Reggio Emilia; Statistics Department, Policlinico di Milano; and S. Biagio Hospital, Alessandria, Italy

Correspondence and requests for reprints should be addressed to Stefano Nava, M.D., Respiratory Unit, Fondazione S. Maugeri, Via Ferrata 8, 27100 Pavia, Italy. E-mail: snava{at}fsm.it

Studies employing noninvasive pressure support ventilation in cardiogenic pulmonary edema have been performed in the intensive care unit when overt respiratory failure is already present and in small groups of patients. In this multicenter study, performed in emergency departments, 130 patients with acute respiratory failure were randomized to receive medical therapy plus O2 (65 patients) or noninvasive pressure support ventilation (65 patients). The primary end point was the need for intubation; secondary end points were in-hospital mortality and changes in some physiological variables. Noninvasive pressure support ventilation improved PaO2/FIO2, respiratory rate, and dyspnea significantly faster. Intubation rate, hospital mortality, and duration of hospital stay were similar in the two groups. In the subgroup of hypercapnic patients noninvasive pressure support ventilation improved PaCO2 significantly faster and reduced the intubation rate compared with medical therapy (2 of 33 versus 9 of 31; p = 0.015). Adverse events, including myocardial infarction, were evenly distributed in the two groups. We conclude that during acute respiratory failure due to cardiogenic pulmonary edema the early use of noninvasive pressure support ventilation accelerates the improvement in PaO2/FIO2, PaCO2, dyspnea, and respiratory rate, but does not affect the overall clinical outcome. Noninvasive pressure support ventilation does, however, reduce the intubation rate in the subgroup of hypercapnic patients.

Key Words: acute respiratory failure • cardiogenic pulmonary edema • chronic obstructive pulmonary disease • noninvasive pressure support ventilation




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