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Crit Care Med. 2002 Nov;30(11):2457-61.

Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema.

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  • 1Service de Réanimation Médicale, Hôpital Raymond Poincaré, Gauches, France.

Abstract

OBJECTIVE:

Continuous positive airway pressure (CPAP) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. However, we hypothesized that bilevel noninvasive positive-pressure ventilation (NPPV), which combines both inspiratory pressure support and positive expiratory pressure, would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP.

DESIGN:

Randomized crossover study.

SETTING:

Critical care unit, Raymond Poincaré Hospital.

PATIENTS:

Six consecutive patients with acute cardiogenic pulmonary edema.

INTERVENTIONS:

Patients were sequentially treated with 5 cm H2O CPAP, 10 cm H2O CPAP, and NPPV in a random order.

MEASUREMENTS AND MAIN RESULTS:

Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence. NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline (p <.05). There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP. NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index.

CONCLUSIONS:

This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema. In addition, NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload, which suggests an improvement in cardiac performance.

PMID:
12441754
[PubMed - indexed for MEDLINE]
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