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J Emerg Med. 2014 Jan;46(1):130-40. doi: 10.1016/j.jemermed.2013.08.015. Epub 2013 Sep 24.

Randomized trial of bilevel versus continuous positive airway pressure for acute pulmonary edema.

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Division of Pulmonary, Critical Care and Sleep Medicine, Lahey Clinic, Burlington, Massachusetts.
Department of Respiratory Care, Rhode Island Hospital, Providence, Rhode Island.
Division of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island.
Department of Respiratory Care, University of North Carolina, Chapel Hill, North Carolina.
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts.



Studies have shown different clinical outcomes of noninvasive positive pressure ventilation (NPPV) from those of continuous positive airway pressure (CPAP).


We evaluated whether bilevel positive airway pressure (BPAP) more rapidly improves dyspnea, ventilation, and acidemia without increasing the myocardial infarction (MI) rate compared to continuous positive pressure ventilation (CPAP) in patients with acute cardiogenic pulmonary edema (APE).


Patients with APE were randomized to either BPAP or CPAP. Vital signs and dyspnea scores were recorded at baseline, 30 min, 1 h, and 3 h. Blood gases were obtained at baseline, 30 min, and 1 h. Patients were monitored for MI, endotracheal intubation (ETI), lengths of stay (LOS), and hospital mortality.


Fourteen patients received CPAP and 13 received BPAP. The two groups were similar at baseline (ejection fraction, dyspnea, vital signs, acidemia/oxygenation) and received similar medical treatment. At 30 min, PaO2:FIO2 was improved in the BPAP group compared to baseline (283 vs. 132, p < 0.05) and the CPAP group (283 vs. 189, p < 0.05). Thirty-minute dyspnea scores were lower in the BPAP group compared to the CPAP group (p = 0.05). Fewer BPAP patients required intensive care unit (ICU) admission (38% vs. 92%, p < 0.05). There were no differences between groups in MI or ETI rate, LOS, or mortality.


Compared to CPAP to treat APE, BPAP more rapidly improves oxygenation and dyspnea scores, and reduces the need for ICU admission. Further, BPAP does not increase MI rate compared to CPAP.


acute pulonary edema; myocardial infarction; noninvasive ventilation

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