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Published ahead of print on September 4, 2003, doi:10.1164/rccm.200211-1270OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1432-1437

A more recent version of this article appeared on December 15, 2003
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Submitted on November 8, 2002
Accepted on August 20, 2003

NONINVASIVE VENTILATION IN CARDIOGENIC PULMONARY EDEMA : A MULTICENTER, RANDOMIZED TRIAL

STEFANO NAVA1*, GIORGIO CARBONE2, NICOLA DIBATTISTA3, ANDREA BELLONE4, PAOLA BAIARDI5, ROBERTO COSENTINI6, MAURO MARENCO7, FABRIZIO GIOSTRA3, GIULIO BORASI2, and PIETRO GROFF3

1 Respiratory Intensive Care Unit, Fondazione S.Maugeri, Istituto Scientifico di Pavia, IRCCS, Pavia, Italy, 2 Emergency, Gradenigo Hospital, Torino, Italy, 3 Emergency, S.Orsola Hospital, Bologna, Italy, 4 Emergency, Correggio Hospital, Correggio, Reggio Emilia, Italy, 5 Statistics, Fondazione S.Maugeri, Istituto Scientifico di Pavia, IRCCS, Pavia, Italy, 6 Emergency, Policlinico di Milano, Milano, Italy, 7 Emergency, San Biagio Hospital, Alessandria, Italy

* To whom correspondence should be addressed. E-mail: snava{at}fsm.it.

Studies employing non-invasive pressure support ventilation in cardiogenic pulmonary edema have been performed in the ICU when overt respiratory failure is already present and in small groups of patients. In this multicenter study, carried out in Emergency Departments, 130 patients with acute respiratory failure were randomized to receive medical therapy+O2 (65 pts) or non-invasive pressure support ventilation (65 pts). The primary end-point was the need for intubation, while secondary end-points were in-hospital mortality and changes in some physiological variables. Non-invasive pressure support ventilation improved Pa02/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 non-invasive pressure support ventilation improved PaCO2 significantly faster and reduced the intubation rate compared to medical therapy (2/33 vs 9/31 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 non-invasive pressure support ventilation accelerates the improvement in PaO2/FiO2, PaCO2, dyspnea and respiratory rate, but does not affect the overall clinical outcome. Non-invasive pressure support ventilation does, however, reduce the intubation rate in the subgroup of hypercapnic patients.
Key words: Cardiogenic Pulmonary Edema - Non-invasive Pressure Support Ventilation - Acute Respiratory Failure - Chronic Obstructive Pulmonary Disease - Randomized Controlled Trial




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