Review of: Collins S, Mielniczuk L, Whittingham H, et al: The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: A systematic review. Annals of Emergency Medicine. 48(3):260-269, 2006
The authors of this study conducted a Medline search of all studies evaluating the use of CPAP in the ED for the treatment of acute cardiogenic pulmonary edema (CHF). The authors compared the effect of standard therapy to CPAP and standard therapy on primary outcomes of mortality and intubation rates.
A pooled patient base from all studies examined showed a significant reduction in both mortality and intubation rates. The authors concluded that adding CPAP to standard therapy was advantageous.
This is the first meta-analysis of studies on the value of noninvasive ventilatory support. The authors of this study examined ranked studies that used BiPAP, as well as those that used CPAP. The authors used very strict exclusion criteria to limit the studies to those that clearly included only CHF patients.
The authors were unable to determine which of the two modalities was superior because of low numbers. While the authors did feel that the data was strong enough to state that the use of noninvasive ventilation in combination with standard therapy should be considered, they did not go as far as to say that its use should be considered standard therapy.
Another issue that this study did not evaluate was what constitutes standard therapy. In CHF, the data supports more aggressive use of nitrates and less use of diuretics.
Since this meta-analysis was published, there have been several other studies examining the value of CPAP in prehospital patients, and these new studies have clearly shown a positive impact.