Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis - PubMed (original) (raw)
Review
Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis
John Victor Peter et al. Lancet. 2006.
Abstract
Background: Non-invasive positive pressure ventilation (NIPPV), using continuous positive airway pressure (CPAP) or bilevel ventilation, has been shown to reduce the need for invasive mechanical ventilation in patients with acute cardiogenic pulmonary oedema. We assessed additional benefits of NIPPV in a meta-analysis.
Methods: Meta-analysis comparison in acute cardiogenic pulmonary oedema was undertaken to compare (1) CPAP with standard therapy (oxygen by face-mask, diuretics, nitrates, and other supportive care), (2) bilevel ventilation with standard therapy, and (3) bilevel ventilation with CPAP, incorporating randomised controlled trials identified by electronic and hand search (1966-May, 2005). In 23 trials that fulfilled inclusion criteria, we assessed the effect of NIPPV on hospital mortality and mechanical ventilation, estimated as relative risks.
Findings: CPAP was associated with a significantly lower mortality rate than standard therapy (relative risk 0.59, 95% CI 0.38-0.90, p=0.015). A non-significant trend towards reduced mortality was seen in the comparison between bilevel ventilation and standard therapy (0.63, 0.37-1.10, p=0.11). We recorded no substantial difference in mortality risk between bilevel ventilation and CPAP (p=0.38). The need for mechanical ventilation was reduced with CPAP (0.44, 0.29-0.66, p=0.0003) and with bilevel ventilation (0.50, 0.27-0.90, p=0.02), compared with standard therapy; but no significant difference was seen between CPAP and bilevel ventilation (p=0.86). Weak evidence of an increase in the incidence of new myocardial infarction with bilevel ventilation versus CPAP was recorded (1.49, 0.92-2.42, p=0.11). Heterogeneity of treatment effects was not evident for mortality or mechanical ventilation across patients' groups.
Interpretation: In patients with acute cardiogenic pulmonary oedema, CPAP and bilevel ventilation reduces the need for subsequent mechanical ventilation. Compared with standard therapy, CPAP reduces mortality; our results also suggest a trend towards reduced mortality after bilevel NIPPV.
Similar articles
- Continuous positive airway pressure versus bilevel noninvasive ventilation in acute cardiogenic pulmonary edema: a randomized multicenter trial.
Moritz F, Brousse B, Gellée B, Chajara A, L'Her E, Hellot MF, Bénichou J. Moritz F, et al. Ann Emerg Med. 2007 Dec;50(6):666-75, 675.e1. doi: 10.1016/j.annemergmed.2007.06.488. Epub 2007 Aug 30. Ann Emerg Med. 2007. PMID: 17764785 Clinical Trial. - Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema.
Vital FM, Ladeira MT, Atallah AN. Vital FM, et al. Cochrane Database Syst Rev. 2013 May 31;(5):CD005351. doi: 10.1002/14651858.CD005351.pub3. Cochrane Database Syst Rev. 2013. PMID: 23728654 Updated. Review. - Non-invasive ventilation in acute cardiogenic pulmonary oedema.
Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Agarwal R, et al. Postgrad Med J. 2005 Oct;81(960):637-43. doi: 10.1136/pgmj.2004.031229. Postgrad Med J. 2005. PMID: 16210459 Free PMC article. Review.
Cited by
- Clinical review of non-invasive ventilation.
Criner GJ, Gayen S, Zantah M, Dominguez Castillo E, Naranjo M, Lashari B, Pourshahid S, Gangemi A. Criner GJ, et al. Eur Respir J. 2024 Nov 7;64(5):2400396. doi: 10.1183/13993003.00396-2024. Print 2024 Nov. Eur Respir J. 2024. PMID: 39227076 Free PMC article. Review. - A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory.
Moury PH, Pasquier V, Greco F, Arvieux JL, Alves-Macedo S, Richard M, Casez-Brasseur M, Skaare K, Jacon P, Durand M, Bedague D, Jaber S, Bosson JL, Albaladejo P. Moury PH, et al. Can J Anaesth. 2023 Jul;70(7):1182-1193. doi: 10.1007/s12630-023-02495-2. Epub 2023 Jun 2. Can J Anaesth. 2023. PMID: 37268802 Clinical Trial. English. - Acute dyspnea in the emergency department: a clinical review.
Santus P, Radovanovic D, Saad M, Zilianti C, Coppola S, Chiumello DA, Pecchiari M. Santus P, et al. Intern Emerg Med. 2023 Aug;18(5):1491-1507. doi: 10.1007/s11739-023-03322-8. Epub 2023 Jun 2. Intern Emerg Med. 2023. PMID: 37266791 Free PMC article. Review. - Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study.
Hirakawa K, Nakayama A, Saitoh M, Hori K, Shimokawa T, Iwakura T, Haraguchi G, Isobe M. Hirakawa K, et al. Int J Environ Res Public Health. 2022 Oct 9;19(19):12918. doi: 10.3390/ijerph191912918. Int J Environ Res Public Health. 2022. PMID: 36232218 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources