Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial.

Journal Article
, Basant Hamdy El-Refay1, Rehab Farrag Gwada2, *, Bassem S. Ibrahim3 . 2015
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Publication Abstract: 

Abstract: This study was to compare the efficacy of continuous, bi-level positive airway pressure (CPAP, Bi-PAP) and

oxygen therapy on detailed observation of time-course change in blood gases, physiological parameters and rate of

endotracheal intubation in patient with acute cardiogenic pulmonary edema (ACPE). Sixty-six patients with ACPE were

randomly assigned to receive standard oxygen (O2) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO2,

PaO2, SaO2, pH, and HCO3), and physiological parameters (HR, RR, SBP, and DBP) were collected at baseline (T0),

immediately after 60 minutes (T60), and after 30 minutes of discontinuation (T90). A significant improvements (p<0.05) in

PaCO2, PaO2, SaO2 and vital signs were observed immediately after CPAP and Bi-PAP when compared to O2 therapy. After 30

minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO2, SaO2, and respiratory rate. No

differences on intubation and death rate detected among treatment groups. Both methods of noninvasive ventilations are

effective treatment for ACPE. However, Bi-PAP should be considered as first line of treatment due to faster and continuous

improvement in oxygenation and respiratory rate.

Keywords: Continuous Positive Airway Pressure, Bi-level Positive Airway Pressure, Acute Cardiogenic Pulmonary Edema