Noninvasive BiPAP Ventilation for Acute Cardiogenic Pulmonary Edema

Background In patients with acute cardiogenic pulmonary edema (ACPE),noninvasive ventilation may be used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. Methods We conducted a prospective, randomized study comparing noninvasive BiPAP ventilation delivered through a face mask with invasive mechanical ventilation in acute cardiogenic pulmonary edema patients admitted to the intensive care unit over a 22-month period. Results A total of 40 patients with ACPO were admitted to the intensive care units in the same period. A total of 20 were randomly assigned to non- invasive BiPAP ventilation and 20 to noninvasive ventilation. The two groups had similar clinical characteristics on admission to the ICU. The use of noninvasive BiPAP ventilation significantly reduced the need for endotracheal intubation, 4 of 20 patients (20%) (P=0.006). In addition, the incidence of mortality was significantly lower in the noninvasive- BiPAP ventilation group (10% vs. 40% in group B, P 0.001), and the mean (±SD) ventilation duration was significantly shorter for patients receiving noninvasive ventilation (33.2±10.98 hours vs. 164.2±65.6 hours respectively, P 0.0001). Conclusions The early application of non-invasive BiPAP in ACPO patients facilitates improvement, decreases need for invasive mechanical ventilation, and decreases mortality, the duration of ventilation and ICU stay.