Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema
OBJECTIVE:To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema. DESIGN:Randomized, controlled trial. SETTING:Tertiary hospital emergen...
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| Veröffentlicht in: | Critical care medicine 2004-12, Vol.32 (12), p.2407-2415 |
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| creator | Park, Marcelo Sangean, Marcia C Volpe, Marcia de S Feltrim, Maria I. Z Nozawa, Emilia Leite, Paulo F Passos Amato, Marcelo B Lorenzi-Filho, Geraldo |
| description | OBJECTIVE:To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.
DESIGN:Randomized, controlled trial.
SETTING:Tertiary hospital emergency room.
PATIENTS:We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.
INTERVENTIONS:Oxygen applied by face mask, CPAP, and bilevel-PAP.
MEASUREMENTS AND MAIN RESULTS:The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the Pao2/Fio2 ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).
CONCLUSIONS:Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies. |
| doi_str_mv | 10.1097/01.CCM.0000147770.20400.10 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67169627</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67169627</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5157-7a9242f54e4107cca95038dd290adc3909a1ae30bc0f254eb233be5d51cda2873</originalsourceid><addsrcrecordid>eNp1kk2P0zAQhiMEYrsLfwFZSHBqyvgj8ZobqlhAWoSE4BxNnAlr1vnATraU38MPxWkr9cQc7MM8M-94XmfZSw4bDka_Ab7Zbj9vIAVXWmvYCFCwJB9lK15IyEEY-ThbARjIpTLyIruM8eeCF1o-zS54URjDlVplf79i3wyd-0PNmo1hiCPZyT0Qm4JDz4aWDb_3P6hfMzv0k-vnYY5sHKI7QOjCDvepjmKcA61ZasZq5-mB_H8pVu9Zi5ZYh_GeuZ6hnSdiFkPjhiTlLBtn3w09hj2jhjp8lj1p0Ud6frqvsu83779tP-a3Xz582r67zW3BC51rNEKJtlCkOGhr0RQgr5tGGMDGSgMGOZKE2kIrElULKWsqmoLbBsW1llfZ62PftIhfM8Wp6ly05D32lN5dlZqXphQL-PYI2rSxGKitxuC6NG_FoVo8qoBXyaPq7FF18CglU_GLk8pcd9ScS0-mJODVCcBo0bcBe-vimStlmSSWRurI7QY_UYj3ft5RqO4I_XR3kJZClbkAUDwd6Vuk0PIfY-at_Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67169627</pqid></control><display><type>article</type><title>Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><creator>Park, Marcelo ; Sangean, Marcia C ; Volpe, Marcia de S ; Feltrim, Maria I. Z ; Nozawa, Emilia ; Leite, Paulo F ; Passos Amato, Marcelo B ; Lorenzi-Filho, Geraldo</creator><creatorcontrib>Park, Marcelo ; Sangean, Marcia C ; Volpe, Marcia de S ; Feltrim, Maria I. Z ; Nozawa, Emilia ; Leite, Paulo F ; Passos Amato, Marcelo B ; Lorenzi-Filho, Geraldo</creatorcontrib><description>OBJECTIVE:To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.
DESIGN:Randomized, controlled trial.
SETTING:Tertiary hospital emergency room.
PATIENTS:We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.
INTERVENTIONS:Oxygen applied by face mask, CPAP, and bilevel-PAP.
MEASUREMENTS AND MAIN RESULTS:The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the Pao2/Fio2 ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).
CONCLUSIONS:Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000147770.20400.10</identifier><identifier>PMID: 15599144</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; APACHE ; Biological and medical sciences ; Blood Gas Analysis ; Continuous Positive Airway Pressure - methods ; Critical Care - methods ; Diseases of the respiratory system ; Electrocardiography ; Emergency and intensive respiratory care ; Emergency Service, Hospital ; Female ; Humans ; Intensive care medicine ; Laryngeal Masks ; Male ; Medical sciences ; Oximetry ; Oxygen - therapeutic use ; Probability ; Prognosis ; Prospective Studies ; Pulmonary Edema - diagnosis ; Pulmonary Edema - mortality ; Pulmonary Edema - therapy ; Pulmonary Gas Exchange ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk Assessment ; Severity of Illness Index ; Shock, Cardiogenic - diagnosis ; Shock, Cardiogenic - mortality ; Shock, Cardiogenic - therapy ; Survival Rate ; Treatment Outcome</subject><ispartof>Critical care medicine, 2004-12, Vol.32 (12), p.2407-2415</ispartof><rights>2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5157-7a9242f54e4107cca95038dd290adc3909a1ae30bc0f254eb233be5d51cda2873</citedby><cites>FETCH-LOGICAL-c5157-7a9242f54e4107cca95038dd290adc3909a1ae30bc0f254eb233be5d51cda2873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16360970$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15599144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Marcelo</creatorcontrib><creatorcontrib>Sangean, Marcia C</creatorcontrib><creatorcontrib>Volpe, Marcia de S</creatorcontrib><creatorcontrib>Feltrim, Maria I. Z</creatorcontrib><creatorcontrib>Nozawa, Emilia</creatorcontrib><creatorcontrib>Leite, Paulo F</creatorcontrib><creatorcontrib>Passos Amato, Marcelo B</creatorcontrib><creatorcontrib>Lorenzi-Filho, Geraldo</creatorcontrib><title>Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.
DESIGN:Randomized, controlled trial.
SETTING:Tertiary hospital emergency room.
PATIENTS:We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.
INTERVENTIONS:Oxygen applied by face mask, CPAP, and bilevel-PAP.
MEASUREMENTS AND MAIN RESULTS:The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the Pao2/Fio2 ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).
CONCLUSIONS:Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.</description><subject>Acute Disease</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Blood Gas Analysis</subject><subject>Continuous Positive Airway Pressure - methods</subject><subject>Critical Care - methods</subject><subject>Diseases of the respiratory system</subject><subject>Electrocardiography</subject><subject>Emergency and intensive respiratory care</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Laryngeal Masks</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Oximetry</subject><subject>Oxygen - therapeutic use</subject><subject>Probability</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Pulmonary Edema - diagnosis</subject><subject>Pulmonary Edema - mortality</subject><subject>Pulmonary Edema - therapy</subject><subject>Pulmonary Gas Exchange</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Shock, Cardiogenic - diagnosis</subject><subject>Shock, Cardiogenic - mortality</subject><subject>Shock, Cardiogenic - therapy</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kk2P0zAQhiMEYrsLfwFZSHBqyvgj8ZobqlhAWoSE4BxNnAlr1vnATraU38MPxWkr9cQc7MM8M-94XmfZSw4bDka_Ab7Zbj9vIAVXWmvYCFCwJB9lK15IyEEY-ThbARjIpTLyIruM8eeCF1o-zS54URjDlVplf79i3wyd-0PNmo1hiCPZyT0Qm4JDz4aWDb_3P6hfMzv0k-vnYY5sHKI7QOjCDvepjmKcA61ZasZq5-mB_H8pVu9Zi5ZYh_GeuZ6hnSdiFkPjhiTlLBtn3w09hj2jhjp8lj1p0Ud6frqvsu83779tP-a3Xz582r67zW3BC51rNEKJtlCkOGhr0RQgr5tGGMDGSgMGOZKE2kIrElULKWsqmoLbBsW1llfZ62PftIhfM8Wp6ly05D32lN5dlZqXphQL-PYI2rSxGKitxuC6NG_FoVo8qoBXyaPq7FF18CglU_GLk8pcd9ScS0-mJODVCcBo0bcBe-vimStlmSSWRurI7QY_UYj3ft5RqO4I_XR3kJZClbkAUDwd6Vuk0PIfY-at_Q</recordid><startdate>200412</startdate><enddate>200412</enddate><creator>Park, Marcelo</creator><creator>Sangean, Marcia C</creator><creator>Volpe, Marcia de S</creator><creator>Feltrim, Maria I. Z</creator><creator>Nozawa, Emilia</creator><creator>Leite, Paulo F</creator><creator>Passos Amato, Marcelo B</creator><creator>Lorenzi-Filho, Geraldo</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200412</creationdate><title>Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema</title><author>Park, Marcelo ; Sangean, Marcia C ; Volpe, Marcia de S ; Feltrim, Maria I. Z ; Nozawa, Emilia ; Leite, Paulo F ; Passos Amato, Marcelo B ; Lorenzi-Filho, Geraldo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5157-7a9242f54e4107cca95038dd290adc3909a1ae30bc0f254eb233be5d51cda2873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Acute Disease</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Blood Gas Analysis</topic><topic>Continuous Positive Airway Pressure - methods</topic><topic>Critical Care - methods</topic><topic>Diseases of the respiratory system</topic><topic>Electrocardiography</topic><topic>Emergency and intensive respiratory care</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Laryngeal Masks</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Oximetry</topic><topic>Oxygen - therapeutic use</topic><topic>Probability</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Pulmonary Edema - diagnosis</topic><topic>Pulmonary Edema - mortality</topic><topic>Pulmonary Edema - therapy</topic><topic>Pulmonary Gas Exchange</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Shock, Cardiogenic - diagnosis</topic><topic>Shock, Cardiogenic - mortality</topic><topic>Shock, Cardiogenic - therapy</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Marcelo</creatorcontrib><creatorcontrib>Sangean, Marcia C</creatorcontrib><creatorcontrib>Volpe, Marcia de S</creatorcontrib><creatorcontrib>Feltrim, Maria I. Z</creatorcontrib><creatorcontrib>Nozawa, Emilia</creatorcontrib><creatorcontrib>Leite, Paulo F</creatorcontrib><creatorcontrib>Passos Amato, Marcelo B</creatorcontrib><creatorcontrib>Lorenzi-Filho, Geraldo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Marcelo</au><au>Sangean, Marcia C</au><au>Volpe, Marcia de S</au><au>Feltrim, Maria I. Z</au><au>Nozawa, Emilia</au><au>Leite, Paulo F</au><au>Passos Amato, Marcelo B</au><au>Lorenzi-Filho, Geraldo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2004-12</date><risdate>2004</risdate><volume>32</volume><issue>12</issue><spage>2407</spage><epage>2415</epage><pages>2407-2415</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.
DESIGN:Randomized, controlled trial.
SETTING:Tertiary hospital emergency room.
PATIENTS:We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.
INTERVENTIONS:Oxygen applied by face mask, CPAP, and bilevel-PAP.
MEASUREMENTS AND MAIN RESULTS:The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the Pao2/Fio2 ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).
CONCLUSIONS:Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>15599144</pmid><doi>10.1097/01.CCM.0000147770.20400.10</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0090-3493 |
| ispartof | Critical care medicine, 2004-12, Vol.32 (12), p.2407-2415 |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Acute Disease Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy APACHE Biological and medical sciences Blood Gas Analysis Continuous Positive Airway Pressure - methods Critical Care - methods Diseases of the respiratory system Electrocardiography Emergency and intensive respiratory care Emergency Service, Hospital Female Humans Intensive care medicine Laryngeal Masks Male Medical sciences Oximetry Oxygen - therapeutic use Probability Prognosis Prospective Studies Pulmonary Edema - diagnosis Pulmonary Edema - mortality Pulmonary Edema - therapy Pulmonary Gas Exchange Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Risk Assessment Severity of Illness Index Shock, Cardiogenic - diagnosis Shock, Cardiogenic - mortality Shock, Cardiogenic - therapy Survival Rate Treatment Outcome |
| title | Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema |
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