Objective
To compare the efficacy of bilevel noninvasive ventilation (NIV), continuous positive airway pressure (CPAP) and oxygen (O2) to prevent orotracheal intubation (OI) in cardiogenic acute pulmonary edema (CAPE).
Methods
In a prospective study, 51 patients (21 male) with CAPE were randomized into three groups of treatment, 6 min after the arrival at the Emergency Unit. Cardiac and respiratory rates, arterial blood pressure and the peripheral oxygen saturation were determined at later randomization moment, 10, 30, 60 min later. Arterial blood samples were collected at the 0, 30, 60 min. Oxygen was applied by face mask with inspiratory fraction (FiO2) of 50%; CPAP and NIV were applied by face mask using BiPAP ST/D 30® with FiO2 of 50% and initial expiratory pressure or initial CPAP of 10 cmH2O and initial inspiratory pressure of 16 cmH2O, both titrated according to necessity.
Results
OI was significantly lower in the group with expiratory pressure support (NIV 1/17 plus CPAP 2/17, total of three intubations in 34 cases) when compared to O2 group (5/15; P < 0.05).
Conclusion
NIV decreased cardiac and respiratory work more rapidly than CPAP and O2. Our data suggest that CPAP and NIV are effective in preventing OI in CAPE.
Table.
| PaO2/FiO2 | RR | SAP | DAP | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Min | NIV | CPAP | O2 | NIV | CPAP | O2 | NIV | CPAP | O2 | NIV | CPAP | O2 |
| 0 | 148 ± 75† | 167 ± 47† | 212 ± 45 | 35 ± 8 | 37 ± 8 | 39 ± 7 | 139 ± 32 | 164 ± 44 | 167 ± 45 | 76 ± 19* | 99 ± 30 | 102 ± 27 |
| 10 | - | - | - | 29 ± 6† | 29 ± 8† | 36 ± 9 | 127 ± 24 | 142 ± 34 | 155 ± 42 | 70 ± 16* | 83 ± 24 | 95 ± 22 |
| 30 | 228 ± 103 | 238 ± 104 | 261 ± 104 | 26 ± 5† | 25 ± 7† | 31 ± 7 | 118 ± 21* | 139 ± 30 | 147 ± 23 | 67 ± 10† | 76 ± 21† | 95 ± 14 |
| 60 | 221 ± 100 | 273 ± 134 | 250 ± 125 | 24 ± 5 | 24 ± 5 | 28 ± 6 | 121 ± 24 | 128 ± 24 | 146 ± 29 | 70 ± 16† | 71 ± 22† | 91 ± 14 |
DAP, diastolic arterial pressure; RR, respiratory rate; SAP, systolic arterial pressure.*P < 0.05 NIV versus O2 and CPAP; †P < 0.05 NIV and CPAP versus O2.