Noninvasive Positive Airway Pressure and Risk of Myocardial Infarction in Acute Cardiogenic Pulmonary Edema: Continuous Positive Airway Pressure vs Noninvasive Positive Pressure Ventilation

摘要

Background: The addition of both noninvasive continuous positive airway pressure (n-CPAP) ornnoninvasive intermittent positive pressure ventilation (n-IPPV) to medical treatment has been shownnto improve the outcome of patients with acute cardiogenic pulmonary edema (ACPE). Previousnstudies indicated a potential risk of new-onset acute myocardial infarction (AMI) associated with thenuse of n-IPPV. Although further studies did not confirm this observation, a few recent metaanalysesncould not eliminate all the doubts at this regards because of the paucity of data available and thenpresence of confounding factors. This study aims to assess whether the application of n-IPPV, asnopposed to n-CPAP, increases the rate of AMI in ACPE patients.nMethods: Fifty-two patients with severe hypoxemia consequent to ACPE were randomized to receivenn-CPAP (n u0001 27) or n-IPPV (n u0001 25) in addition to medical therapy. Patients with signs of acutencoronary syndrome on hospital admission were excluded from the study. Cardiac markers, ECG, andnclinical/physiologic parameters were assessed at study entry, after 30 and 60 min, and every6hfornthe first 2 days.nResults: No significant difference was observed in the rate of AMI (26.9% and 16% with n-CPAP andnn-IPPV, respectively, p u0001 0.244). Rate of intubation (p u0001 0.481), death (p u0001 0.662), and hospital stayn(p u0001 0.529) were not different between the two groups. Both techniques were effective in improvingngas exchange and vital signs in patients with ACPE.nConclusions: The AMI rate was not different with n-CPAP and n-IPPV, which resulted to be equallyneffective in the treatment of ACPE.nTrial registration: Clinicaltrials.gov Identifier: NCT00453947. (CHEST 2007; 132:1804–1809)