Prof. David Newby,
View the slides This multicentre randomised controlled trial of the early management of patients with acute cardiogenic pulmonary oedema (the 3CPO study) compared two intervention arms (continuous positive airways pressure [CPAP] and non-invasive intermittent positive pressure ventilation [NIPPV]) with standard oxygen therapy. 1069 patients (mean age 78 years; 43% male) were recruited into the trial and were randomised to standard oxygen therapy (n=367), CPAP (n=346; 10±4 cmH2O) or NIPPV (356; 14±5/7±2 cmH2O). At entry, patients were tachycardic (heart rate 113±22 /min), acidotic (pH 7.25±0.11), tachypneic (respiratory rate 32±7 /min) and hypoxic (oxygen saturation 90±8%). In comparison to standard oxygen therapy, non-invasive ventilation was associated with greater improvements in tachycardia (102±23 versus 96±22 /min, P<0.001), acidosis (pH 7.33±0.11 versus 7.36±0.11, P=0.002) and tachypnea (26±6 versus 25±6, P=0.023) at one hour. The 7-day and 30-day mortality was similar for standard oxygen therapy and non-invasive ventilation (9.8% versus 9.5% (p=0.869) and 16.6% versus 15.6% (p=0.685) respectively). The combined end-point of 7-day death or intubation rate was similar for both forms of non-invasive ventilation (11.7% versus 11.1%, CPAP versus NIPPV; P=0.806). There was a high rate of acute myocardial infarction (~50%) that was similar in all three groups.
In patients with acute cardiogenic pulmonary edema, non-invasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance with both CPAP and NIPPV appearing to be equally efficacious. However, non-invasive ventilation has no major effect on short-term mortality.
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