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Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema

Cochrane database of systematic reviews, 2019-04, Vol.2019 (4), p.CD005351-CD005351 [Peer Reviewed Journal]

Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ;EISSN: 1465-1858 ;EISSN: 1469-493X ;DOI: 10.1002/14651858.CD005351.pub4 ;PMID: 30950507

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  • Title:
    Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema
  • Author: Berbenetz, Nicolas ; Wang, Yongjun ; Brown, James ; Godfrey, Charlotte ; Ahmad, Mahmood ; Vital, Flávia MR ; Lambiase, Pier ; Banerjee, Amitava ; Bakhai, Ameet ; Chong, Matthew ; Berbenetz, Nicolas
  • Subjects: Acute heart failure ; Adult ; Continuous Positive Airway Pressure ; Continuous Positive Airway Pressure - adverse effects ; Continuous Positive Airway Pressure - methods ; G. Acute Heart Failure ; Heart & circulation ; Heart failure ; Hospital Mortality ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Intubation, Intratracheal - statistics & numerical data ; Length of Stay ; Lungs & airways ; Medicine General & Introductory Medical Sciences ; Noninvasive Ventilation ; Pain & anaesthesia ; Peri‐anaesthetic/peri‐operative care ; Pulmonary Edema ; Pulmonary Edema - therapy ; Randomized Controlled Trials as Topic ; Ventilation ; Ventilation in peri‐anaesthetic/critical care
  • Is Part Of: Cochrane database of systematic reviews, 2019-04, Vol.2019 (4), p.CD005351-CD005351
  • Description: Background Non‐invasive positive pressure ventilation (NPPV) has been used to treat respiratory distress due to acute cardiogenic pulmonary oedema (ACPE). We performed a systematic review and meta‐analysis update on NPPV for adults presenting with ACPE. Objectives To evaluate the safety and effectiveness of NPPV compared to standard medical care (SMC) for adults with ACPE. The primary outcome was hospital mortality. Important secondary outcomes were endotracheal intubation, treatment intolerance, hospital and intensive care unit length of stay, rates of acute myocardial infarction, and adverse event rates. Search methods We searched CENTRAL (CRS Web, 20 September 2018), MEDLINE (Ovid, 1946 to 19 September 2018), Embase (Ovid, 1974 to 19 September 2018), CINAHL Plus (EBSCO, 1937 to 19 September 2018), LILACS, WHO ICTRP, and clinicaltrials.gov. We also reviewed reference lists of included studies. We applied no language restrictions. Selection criteria We included blinded or unblinded randomised controlled trials in adults with ACPE. Participants had to be randomised to NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care (SMC) compared with SMC alone. Data collection and analysis Two review authors independently screened and selected articles for inclusion. We extracted data with a standardised data collection form. We evaluated the risks of bias of each study using the Cochrane 'Risk of bias' tool. We assessed evidence quality for each outcome using the GRADE recommendations. Main results We included 24 studies (2664 participants) of adult participants (older than 18 years of age) with respiratory distress due to ACPE, not requiring immediate mechanical ventilation. People with ACPE presented either to an Emergency Department or were inpatients. ACPE treatment was provided in an intensive care or Emergency Department setting. There was a median follow‐up of 13 days for hospital mortality, one day for endotracheal intubation, and three days for acute myocardial infarction. Compared with SMC, NPPV may reduce hospital mortality (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; participants = 2484; studies = 21; I2 = 6%; low quality of evidence) with a number needed to treat for an additional beneficial outcome (NNTB) of 17 (NNTB 12 to 32). NPPV probably reduces endotracheal intubation rates (RR 0.49, 95% CI 0.38 to 0.62; participants = 2449; studies = 20; I2 = 0%; moderate quality of evidence) with a NNTB of 13 (NNTB 11 to 18). There is probably little or no difference in acute myocardial infarction (AMI) incidence with NPPV compared to SMC for ACPE (RR 1.03, 95% CI 0.91 to 1.16; participants = 1313; studies = 5; I2 = 0%; moderate quality of evidence). We are uncertain as to whether NPPV increases hospital length of stay (mean difference (MD) −0.31 days, 95% CI −1.23 to 0.61; participants = 1714; studies = 11; I2 = 55%; very low quality of evidence). Adverse events were generally similar between NPPV and SMC groups, but evidence was of low quality. Authors' conclusions Our review provides support for continued clinical application of NPPV for ACPE, to improve outcomes such as hospital mortality and intubation rates. NPPV is a safe intervention with similar adverse event rates to SMC alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.
  • Publisher: Chichester, UK: John Wiley & Sons, Ltd
  • Language: English
  • Identifier: EISSN: 1465-1858
    EISSN: 1469-493X
    DOI: 10.1002/14651858.CD005351.pub4
    PMID: 30950507
  • Source: MEDLINE
    Alma/SFX Local Collection
    Cochrane Library (Open Aceess)
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