November 1, 2002Critical Care Medicine
Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema
Authors
Discussion
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Implication
Randomized crossover study reveals superior respiratory muscle unloading with noninvasive ventilation over CPAP in acute cardiogenic pulmonary edema, indicating enhanced hemodynamic performance.
Key Points
- To determine whether bilevel noninvasive positive-pressure ventilation (NPPV) unloads respiratory muscles and improves cardiac and hemodynamic function more effectively than continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary edema.
- Randomized crossover study conducted in the critical care unit of Raymond Poincaré Hospital.
- Six consecutive patients with severe acute cardiogenic pulmonary edema were sequentially treated in a random order with 5 cm H2O CPAP, 10 cm H2O CPAP, and bilevel NPPV.
- Cardiac, hemodynamic, and respiratory mechanics parameters were assessed during each treatment sequence.
- NPPV significantly reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline (p < .05), whereas CPAP produced no significant reductions.
- Both NPPV and 10 cm H2O CPAP reduced mean transmural right and left atrial filling pressures without altering the cardiac index.
Cite This Study
Chadda et al. (2002) studied this question.