Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema

Abstract

Objective: This study compared noninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) in patients with acute hypercapnic pulmonary edema with regard to resolution time. Design and setting: Randomized prospective study in an emergency department. Patients and participants: We randomly assigned 36 patients with respiratory failure due to acute pulmonary edema and arterial hypercapnia (PaCO2 >45 mmHg) to NIPSV (n=18) or CPAP through a face mask (n=18). Measurements and results: Electrocardiographic and physiological measurements were made over 36 h. There was no difference in resolution time defined as clinical improvement with a respiratory rate of fewer than 30 breaths/min and SpO2 of 96% or more between CPAP and NIPSV groups. Arterial carbon dioxide tension was significantly decreased after 1 h of ventilation (CPAP, 60.5±13.6 to 42.8±4.9 mmHg; NIPSV, 65.7±13.6 to 44.0±5.5 mmHg); respective improvements were seen in pH (CPAP, 7.22±0.11 to 7.37±0.04; NIPSV, 7.19±0.11 to 7.38±0.04), SpO2 (CPAP, 86.9±3.7% to 95.1±2.6%; NIPSV, 83.7±6.6% to 96.0±2.9%), and respiratory rate (CPAP, 37.9±4.5 to 21.3±5.1 breaths/min; NIPSV, 39.8±4.4 to 21.2±4.6 breaths/min). No significant differences were seen with regards to endotracheal intubation and in-hospital mortality. Conclusions: NIPSV proved as effective as CPAP in the treatment of patients with acute pulmonary edema and hypercapnia but did not improve resolution time. © Springer-Verlag 2005.