Ventilation & weaning · Non-invasive support in cardiogenic pulmonary oedema
Treatment of severe cardiogenic pulmonary edema with CPAP delivered by face mask
| Design | Randomised controlled trial |
|---|---|
| Treatment | Oxygen plus continuous positive airway pressure by face mask |
| Control | Oxygen alone |
| Population | 39 patients with severe cardiogenic pulmonary oedema |
| Follow-up | Hospital admission |
| Primary endpoint | Physiological improvement and need for intubation at 30 minutes |
| Result | At 30 minutes respiratory rate went from 32 to 33 breaths per minute on oxygen alone and from 35 to 27 with CPAP (p=0.008). Arterial carbon dioxide tension fell from 64 to 62 mmHg with oxygen and from 58 to 46 mmHg with CPAP (p<0.001), with a greater rise in arterial pH. CPAP reduced the need for intubation and mechanical ventilation. |
| Secondary endpoints | Arterial pH, oxygenation, hospital mortality |
Continuous positive airway pressure delivered by face mask in patients with severe cardiogenic pulmonary edema can result in early physiologic improvement and reduce the need for intubation and mechanical ventilation. This short-term study could not establish whether continuous positive airway pressure has any long-term benefit or whether a larger study would have shown a difference in mortality between the treatment groups.
The trial authors, in the published abstract
The trial that introduced mask CPAP for pulmonary oedema, and admirably explicit that 39 patients could say nothing about mortality. 3CPO eventually enrolled 1069 and confirmed exactly that: the physiology improves, the survival does not.
Bersten AD, Holt AW, Vedig AE, et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991 Dec 26;325(26):1825-30.