Abstract 308 Noninvasive positive airway pressure ventilation and risk of myocardial infarction in acute cardiogenic pulmonary edema: continuous positive airway pressure versus noninvasive positive pressure ventilation

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

“…We identified 20 relevant RCTs. 45,54,57,59,61,62 or all three of these treatments. 50,56,64,65 Before publication of a recent large RCT, 65 which accounted for 40% of all patients who have been studied in RCTs of continuous positive airway pressure for cardiogenic pulmonary edema and 70% of patients receiving noninvasive positive-pressure ventilation for this indication, five separate systematic reviews [162][163][164][165][166] had consistently demonstrated a significant reduction in endotracheal intubation with both types of noninvasive ventilation.…”

“…In addition, 9 of these 15 trials, and 8 of the 10 trials in the period 2005 through 2009, also excluded patients who required acute coronary revascularization 48,53,56,61,62,64,65 or who had acute coronary syndrome. 54,59 Hence, it is difficult to extend recommendations to these specific popu lations. An early RCT suggested that noninvasive positive-pressure ventilation was associated with a greater risk of myocardial infarction than was continuous positive airway pressure, 45 …”

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

“…Recently, Nouira et al, [20] showed that Bi-PAP improves respiratory failure, while, Masip et al, [21] showed a decrease in intubation rate in Bi-PAP group when compared with CPAP. However, other studies [10,22] failed to demonstrate significant differences in vital signs, blood gases, and rate of myocardial infarction between two modes of ventilations and between Bi-PAPA and oxygen therapy [23]. Moreover, Gray et al, [24] did not find the difference in intubation or mortality rates with either CPAP or Bi-PAP compared to oxygen therapy.…”

“…Exclusion criteria were: requirement for a life-saving or emergency intervention, such as primary percutaneous coronary intervention, or chronic obstructive pulmonary diseases, hemodynamic instability (systolic BP ≤ 90mmHg), or life-threatening arrhythmia, acute myocardial infarction and/ or unstable angina, recent facial trauma, and esophageal/gastric surgery, gastrointestinal bleeding, or pregnant [22,28].…”

Noninvasive Ventilation in Patients With Acute Cardiogenic Pulmonary Edema With Acute Coronary Syndrome: Is the Debate Still?

“…At least 2 studies have observed that NIV [either pressure support ventilation (PSV) + positive end-expiratory pressure] or continuous positive airway pressure (CPAP) do not increase the myocardial infarction (MI) rate in patients with ACPE. 1, 2 Moreover, in a recent meta-analysis, 3 the authors observed that the effect of NIV was more prominent among patients in whom MI or ischemia was the cause of pulmonary edema; in fact, use of CPAP, if compared with standard medical therapy, was associated with a significant reduction in hospital mortality among patients whose pulmonary edema was caused by acute MI (AMI) or ischemia. However, the number of patients studied was low and it was not clearly defined if NIV was efficacious in patients with ACPE secondary to AMI or ischemia.…”