Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: A Meta-Analysis of Randomized Controlled Trials

• Published in: Journal of cardiac failure Vol. 17; no. 10; pp. 850 - 859
• Main Authors: Mariani, Javier, MD, Macchia, Alejandro, MD, Belziti, César, MD, DeAbreu, Maximiliano, MD, Gagliardi, Juan, MD, Doval, Hernán, MD, Tognoni, Gianni, MD, Tajer, Carlos, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2011
• Subjects: acute heart failure; Cardiovascular; Continuous positive airway pressure; Humans; noninvasive positive pressure ventilation; Positive-Pressure Respiration; pulmonary edema; Pulmonary Edema - therapy; Randomized Controlled Trials as Topic; Treatment Outcome; pulmonary edema; acute heart failure; Continuous positive airway pressure; noninvasive positive pressure ventilation
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2011.05.010

Abstract Background The evidence of individual studies in acute cardiogenic pulmonary edema (ACPE) supporting noninvasive ventilation (NIV) is still inconclusive, particularly regarding noninvasive positive pressure ventilation (NIPPV). Methods We carried out a meta-analysis. We searched in the Embase, Medline, Cinahl, Dare, Coch, Central, and CNKI databases and congress abstracts for trials comparing continuous positive airway pressure (CPAP) or NIPPV with standard therapy (ST). To assess treatment effects, we carried out direct comparison using a random effects model and adjusted indirect comparison. Results At total of 34 studies (3,041 patients) were included. In direct comparisons, both CPAP and NIPPV reduced the risk of death (relative risk [RR] 0.64, 95% CI 0.44–0.93; RR 0.80, 95% CI 0.58–1.10; respectively) compared with ST, although only CPAP had a significant effect. There were no significant differences between NIPPV and CPAP. Pooled results of direct and adjusted indirect comparisons showed that compared with ST, both CPAP and NIPPV significantly reduced mortality (RR 0.63, 95% CI 0.44–0.89; RR 0.73, 95% CI 0.55–0.97; respectively). Conclusions Our findings suggest that among ACPE patients, NIV delivered through either NIPPV or CPAP reduced mortality.