Myocardial infarction rate in acute pulmonary edema: Noninvasive pressure support ventilation versus continuous positive airway pressure

Abstract

NIPSV proved to be equally effective in improving vital signs and ventilation without increasing acute myocardial infarction rate in patients with nonischemic acute pulmonary edema in comparison to CPAP alone. However, because the study lacked statistical power and excluded patients with acute coronary syndromes, caution is still advised when applying NIPSV to the latter subgroup of patients.

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.…”

“…Many studies revealed that, CPAP improved arterial oxygenation (PaO 2 ), and reduces endotracheal intubation rate [9][10][11] and mortality rate in ACPE [12,13]. However, other studies failed to show these effects [14][15][16].…”

“…In the CPAP group, a continuous pressure of 10 cmH 2 O was generated. Patients in Bi-PAP group received IPAP (15cmH 2 O) and EPAP (5cmH 2 O) [10,13,14]. All patients received their assigned treatment for 1 hour.…”

“…Over the past three decades, application of noninvasive ventilation (NIV) either with continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (Bi-PAP) has been used with the standardized medical treatment as an effective therapeutic approach to treat ACPE [5][6][7][8][9][10].…”

Is the noninvasive ventilatory mode of importance during cardiogenic pulmonary edema?

“…The fact that these myocardial infarcts preceded inclusion or were the direct result of the ventilator mode was questioned. In a subsequent randomized study, Bellone et al [26], however, concluded that CPAP and NIPPSV were equivalent in terms of clinical parameters improvement, but also in terms of myocardial infarction rate or troponin plasma levels increase. In all subsequent clinical comparisons, both CPAP and NIPPSV proved superior to medical therapy alone in terms of reducing the intubation rate [27,28], without any adverse event rate or outcome differences.…”