Key result
APACHE II score >20 strongly predicts BiPAP need in cardiogenic pulmonary edema with ~95% sensitivity.
Why the study?
Non-invasive ventilation, particularly BiPAP, has emerged as an alternative to conventional oxygen therapy in ACPE, but comparative data on efficacy and safety are needed.
Does bilevel noninvasive ventilation improve clinical and physiological parameters compared to conventional oxygen therapy in patients with acute cardiogenic pulmonary edema?
Observational (n=100)
Open-label
None (text claims randomization but explicitly describes allocation by physician choice based on clinical condition)
No
Does bilevel noninvasive ventilation improve clinical and physiological parameters compared to conventional oxygen therapy in patients with acute cardiogenic pulmonary edema?
Absolute Event Rate: 13.6% vs 9.74%
p-value: p=<0.001
Bilevel non-invasive ventilation is an effective therapeutic modality for patients with acute cardiogenic pulmonary edema, particularly benefiting those with severe cardiac dysfunction and higher APACHE II scores.
APACHE II >20 identifies BiPAP candidates in acute cardiogenic pulmonary edema; extends severity-based stratification in NIV RCTs.
Background: Acute cardiogenic pulmonary edema(ACPE) is a life-threatening emergency associated with acute respiratory failure and significant mortality. Non-invasive ventilation, particularly bilevel positive airway pressure (BiPAP), has emerged as an effective alternative to conventional oxygen therapy (COT) in improving oxygenation and reducing respiratory distress. This study aimed to compare the efficacy and safety of BiPAP with conventional oxygen therapy in the management of ACPE.Methodology:This prospective randomized comparative study included 100 patients diagnosed with ACPE admitted to the emergency department. Patients were randomly divided into two groups: Group I received BiPAP along with standard anti-failure treatment, while Group II received conventional face mask oxygen therapy withanti-failure measures. Clinical examination, arterial blood gas analysis, electrocardiography, echocardiography, APACHE II scoring, and laboratory investigations were performed in all patients. Statistical analysis was conducted using SPSS version 25.0, and p<0.05 was considered statistically significant.Result:Patients with decompensated heart failure, ischemic heart disease, valvularheart disease, elevated pulmonary artery systolic pressure, and reduced ejection fraction showed significantly higher use of BiPAP (p<0.05). Echocardiographic abnormalities including RWMA, severe mitral regurgitation, and advanced diastolic dysfunction were more common in the BiPAP group. APACHE II score >20 demonstrated high sensitivity and specificity in predicting BiPAP requirement.Conclusion:BiPAP is an effective and safe modality in patients with acute cardiogenic pulmonary edema, especially among those with severe cardiac dysfunction and respiratory compromise. Early initiation of BiPAP may improve clinical outcomes and reduce progression to invasive ventilation.
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K et al. (2026) conducted an observational in Acute cardiogenic pulmonary edema (n=100). Bilevel positive airway pressure (BiPAP) vs. Conventional oxygen therapy was evaluated on Length of hospital stay (days) (p=<0.001). An APACHE II score >20 strongly predicted the need for BiPAP therapy with 95% sensitivity and 100% specificity in patients with acute cardiogenic pulmonary edema.
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