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Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema
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Vital, Flávia MR, Saconato, Humberto, Ladeira, Magdaline T, Sen, Ayan, Hawkes, C. M., Soares, Bernardo, Burns, Karen E. A. and Atallah, Álvaro N (2008) Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database of Systematic Reviews, 3 . CD005351. doi:10.1002/14651858.CD005351.pub2 ISSN 1469-493X.
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Official URL: http://dx.doi.org/10.1002/14651858.CD005351.pub2
Abstract
BACKGROUND:
Non-invasive positive pressure ventilation (NPPV) has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing.
OBJECTIVES:
To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary edema.
SEARCH STRATEGY:
We undertook a comprehensive search of the following databases in April 2005: CENTRAL, MEDLINE, EMBASE, CINAHL, DARE and LILACS. We also reviewed reference lists of included studies and contacted experts, equipment manufacturers, and the Cochrane Heart Group. We did not apply language restrictions.
SELECTION CRITERIA:
We selected blinded or unblinded randomized or quasi-randomized clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and where NPPV (continuous positive airway pressure (CPAP)) and/or bilevel NPPV plus standard medical care was compared with standard medical care alone.
DATA COLLECTION AND ANALYSIS:
Two authors independently selected articles and abstracted data using a standardized data collection form. We evaluated study quality with emphasis on allocation concealment, adherence to the intention-to-treat principle and losses to follow-up.
MAIN RESULTS:
We included 21 studies involving 1,071 participants. Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83) with numbers needed to treat of 13 and 8, respectively. We found no difference in hospital length of stay with NPPV, however, intensive care unit stay was reduced by 1 day (WMD -1.07 days, 95% CI -1.60 to -0.53). Compared to standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.82, 95% CI 0.09 to 7.54) its application.
AUTHORS' CONCLUSIONS:
NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Cochrane Database of Systematic Reviews | ||||
Publisher: | John Wiley & Sons Ltd. | ||||
ISSN: | 1469-493X | ||||
Book Title: | Cochrane Database of Systematic Reviews | ||||
Official Date: | 16 July 2008 | ||||
Dates: |
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Volume: | 3 | ||||
Article Number: | CD005351 | ||||
DOI: | 10.1002/14651858.CD005351.pub2 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access |
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