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Title: “The 52 in 52 Review: Noninvasive ventilation in acute cardiogenic pulmonary edema”

 

Article Citation: Masip J, Roque M, Sánchez B, Fernández R, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005 Dec 28;294(24):3124-30.PMID: 16380593

 

What we already know about the topic: For acute pulmonary edema, noninvasive ventilation is often used for respiratory support.

 

Why this study is important: Does noninvasive ventilation for acute pulmonary edema reduce rate of intubation? Does it change mortality? How does it compare to conventional oxygen therapy?

 

Brief overview of the study: This was a systemic review and meta-analysis, involving fifteen trials. Noninvasive ventilation, overall, was noted noted to reduce mortality by nearly 45%, when compared to conventional therapy. This was significant for continuous positive airway pressure (CPAP), but not for bilevel noninvasive pressure support ventilation (NIPSV). Both did, however, reduce the need for intubation, when compared to conventional therapy.

 

Limitations: (1) Criteria for the diagnosis of acute pulmonary edema are not well established. (2) NIPSV machines and training in using them was not identical across studies. (3) Some patients on CPAP were put on rescue NIPSV, and some in conventional therapy group were placed on rescue noninvasive ventilation (CPAP or NIPSV). This would of course introduce some bias.

 

Take home points: Use noninvasive ventilation for acute cardiogenic pulmonary edema, as this intervention reduces the need for intubation and reduces mortality.

 

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