Ventilation & weaning · Non-invasive support in cardiogenic pulmonary oedema
Three interventions in Cardiogenic Pulmonary Oedema
| Design | Multicentre randomised controlled trial with three arms |
|---|---|
| Treatment | CPAP, or non-invasive positive-pressure ventilation |
| Control | Standard oxygen therapy |
| Population | 1069 patients with acute cardiogenic pulmonary oedema, mean age 77.7 years, 56.9% women |
| Follow-up | 30 days |
| Primary endpoint | 7-day mortality for non-invasive ventilation versus standard oxygen therapy |
| Result | Seven-day mortality was 9.8% with standard oxygen and 9.5% with non-invasive ventilation (p=0.87). The combined endpoint of death or intubation within 7 days also did not differ. Non-invasive ventilation produced faster improvement in respiratory distress and metabolic disturbance. |
| Secondary endpoints | Death or intubation at 7 days, physiological improvement, 30-day mortality |
In patients with acute cardiogenic pulmonary edema, noninvasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance than does standard oxygen therapy but has no effect on short-term mortality.
The trial authors, in the published abstract
A large, definitive trial that separates symptomatic benefit from survival benefit — both real findings, often conflated. Use non-invasive support in cardiogenic pulmonary oedema to relieve distress, and do not claim it reduces mortality.
Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008 Jul 10;359(2):142-51.