Clinical Citations: Noninvasive ventilation benefits patients with acute pulmonary edema

Because of the potential complications associated with mechanical ventilation, noninvasive ventilation is considered an attractive alternative in some settings. How useful is it in patients with acute cardiogenic pulmonary edema? Researchers who addressed this question found that the early application of noninvasive ventilation in the emergency department (ED) can decrease the relative risk of mortality by 39% and the need for endotracheal intubation by 57%.

The researchers reviewed 11 trials selected from 22,658 relevant studies; inclusion criteria included randomized trials in which acute cardiogenic pulmonary edema was diagnosed in patients older than 18 years. Their meta-analysis included a comparison of continuous positive airway pressure, noninvasive positive pressure ventilation, and standard medical therapy.

A pooled analysis of 494 patients revealed that the addition of noninvasive ventilation to standard medical therapy significantly reduced hospital mortality compared with standard medical therapy alone (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.41, 0.91), and a meta-analysis of 436 patients indicated that noninvasive ventilation was associated with a significant decrease in intubation rates (RR, 0.43; 95% CI, 0.21, 0.87). The researchers concluded that noninvasive ventilation in conjunction with standard medical therapy leads to better outcomes than does standard therapy alone in ED patients with acute cardiogenic pulmonary edema.