cc1338 CCJ Meeting abstract <p>Comparison among bilevel noninvasive mechanical ventilation, continuous positive airway pressure and oxygen in the treatment of cardiogenic acute pulmonary edema</p> Park M Sangeam MC Volpe MS Leite PF Viecilli PRN Feltrim MIZ Nozawa E Lorenzi-Filho G Timerman S Cardoso LF Ramires JAF

Heart Institute, University of São Paulo, Medical School, São Paulo, Brazil

 Critical Care <p>First International Symposium on Intensive Care and Emergency Medicine for Latin America:</p> Meeting abstracts <p>First International Symposium on Intensive Care and Emergency Medicine for Latin America:</p> São Paulo, Brazil 26–29 June 2001 1364-8535 2001 5 Suppl 3 P5 10.1186/cc1338 26 6 2001 cc-5-s3-p05

Objective

To compare the efficacy of bilevel noninvasive ventilation (NIV), continuous positive airway pressure (CPAP) and oxygen (O2) to prevent orotracheal intubation (OI) in cardiogenic acute pulmonary edema (CAPE).

Methods

In a prospective study, 51 patients (21 male) with CAPE were randomized into three groups of treatment, 6 min after the arrival at the Emergency Unit. Cardiac and respiratory rates, arterial blood pressure and the peripheral oxygen saturation were determined at later randomization moment, 10, 30, 60 min later. Arterial blood samples were collected at the 0, 30, 60 min. Oxygen was applied by face mask with inspiratory fraction (FiO2) of 50%; CPAP and NIV were applied by face mask using BiPAP ST/D 30® with FiO2 of 50% and initial expiratory pressure or initial CPAP of 10 cmH2O and initial inspiratory pressure of 16 cmH2O, both titrated according to necessity.

Results

OI was significantly lower in the group with expiratory pressure support (NIV 1/17 plus CPAP 2/17, total of three intubations in 34 cases) when compared to O2 group (5/15; P < 0.05).

Conclusion

NIV decreased cardiac and respiratory work more rapidly than CPAP and O2. Our data suggest that CPAP and NIV are effective in preventing OI in CAPE.

<p>Table</p>

PaO2/FiO2

RR

SAP

DAP

Min

NIV

CPAP

O2

NIV

CPAP

O2

NIV

CPAP

O2

NIV

CPAP

O2

0

148 ± 75†

167 ± 47†

212 ± 45

35 ± 8

37 ± 8

39 ± 7

139 ± 32

164 ± 44

167 ± 45

76 ± 19*

99 ± 30

102 ± 27

10

-

-

-

29 ± 6†

29 ± 8†

36 ± 9

127 ± 24

142 ± 34

155 ± 42

70 ± 16*

83 ± 24

95 ± 22

30

228 ± 103

238 ± 104

261 ± 104

26 ± 5†

25 ± 7†

31 ± 7

118 ± 21*

139 ± 30

147 ± 23

67 ± 10†

76 ± 21†

95 ± 14

60

221 ± 100

273 ± 134

250 ± 125

24 ± 5

24 ± 5

28 ± 6

121 ± 24

128 ± 24

146 ± 29

70 ± 16†

71 ± 22†

91 ± 14

DAP, diastolic arterial pressure; RR, respiratory rate; SAP, systolic arterial pressure.*P < 0.05 NIV versus O2 and CPAP; †P < 0.05 NIV and CPAP versus O2.