Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema ED Patients

Street Science


 
 

Keith Wesley | | Wednesday, June 27, 2007


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 Science

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.

The Street

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.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Airway and Respiratory, Medical Emergencies, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Progress

Follow in the footsteps of these inspirational leaders of EMS.
More >

Multimedia Thumb

Four Killed in New Mexico Medical Plane Crash

Crash near fairgrounds claims patient and crew of three.
Watch It >


Multimedia Thumb

Texas Ambulance Involved in Crash

Odessa ambulance and car collide during response.
Watch It >


Multimedia Thumb

Las Vegas Fire, AMR Reach New Deal

Tentative agreement reached over ambulance calls.
Watch It >


Multimedia Thumb

Fire Damages Several Homes in California Earthquake

Four homes destroyed and others damaged after quake rattles Napa.
Watch It >


Multimedia Thumb

New Mexico Air Ambulance Crash

NTSB investigates crash that killed four.
More >


Multimedia Thumb

Where in the World of EMS is A.J.? Scranton

JEMS Editor-in-Chief visits his hometown of Scranton, Pa.
More >


Multimedia Thumb

Over 100 Injured in California Earthquake

172 patients treated at Napa hospital after 6.0-magnitude earthquake.
More >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


More Product Videos >