Non Invasive Positive Pressure Ventilation in Treatment of Acute Cardiogenic Pulmonary Edema

Background: Noninvasive positive-pressure ventilation (NPPV) appears to be of benefit in the treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality. Aim of the Work: To determine whether NPPV of immediate benefit, in adults with acute cardiogenic pulmonary edema and whether there are important differences in outcome associated with this method of treatment regarding hospital mortality, rate of endotracheal intubation and Intensive Care Unit (ICU) length of stay. Methods: In randomised controlled trial, thirty patients with acute cardiogenic pulmonary edema (ACPE) were enrolled in the study and divided into two groups. Group I: Included 15 patients who were assigned to NPPV through oronasal mask with (inspiratory pressure, 8 to 20cm of water; expiratory pressure, 4 to 1 0cm of water). Group II: Included 15 patients who were assigned to standard oxygen therapy through oxygen mask. Both groups are compared regarding the following parameter: Arterial blood gases, vital signs and degree of dyspnea on admission, 1-hour and 2- hours post intervention and after discontinuation of treatment. Both groups are compared regarding the rate of endotracheal intubation, ICU length of stay and hospital mortality. Results: A total of 30 patients with mean age is (68.9±5.5) years and female sex 53.3%. As compared with standard oxygen therapy, noninvasive positive pressure ventilation was associated with early greater mean improvements regarding to dyspnea score (6.8±0.8 Vs. 7.8±0.9, p-value 0.003), respiratory rate (27±3 Vs. 33±2, p-value 0.00 1), heart rate (100±9 Vs. 112±6, p-value 0.001), oxygen saturation (94±3 Vs. 90±4, p-value 0.005) and arterial oxygen pressure (83.8±12.1 Vs. 75.4±9.5, p- value 0.044). There was no significant difference in mortality rate or endotracheal intubation rate but there was significant difference in mean ICU length of stay (6.6±1.6 Vs. 8.2±1.3, p-value 0.006) between patients receiving versus standard O2 therapy noninvasive positive pressure ventilation. Conclusions: Patients with acute cardiogenic pulmonary edema, noninvasive ventilation safely provides earlier improvement of dyspnea, respiratory distress and oxygen saturation, and decrease ICU length of stay than does standard oxygen therapy. However, these effects do not result in improved endotracheal intubation or survival rate. We recommend that noninvasive positive pressure ventilation be considered as adjunctive therapy in patients with acute cardiogenic pulmonary edema who have severe respiratory distress or whose condition does not improve with pharmacologic therapy.