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Noninvasive Ventilation Offers No Mortality Benefit in Acute Cardiogenic Pulmonary Edema

Noninvasive ventilation offers no short-term survival benefit over standard oxygen therapy in older adults with acute cardiogenic pulmonary edema, the New England Journal of Medicine reports.

Nearly 1100 patients (mean age, 78) presenting with cardiogenic pulmonary edema were randomized to standard oxygen therapy or noninvasive ventilation (continuous positive airway pressure or noninvasive intermittent positive-pressure ventilation). Mortality at 7 days did not differ between the standard-therapy and noninvasive-ventilation groups (roughly 10%). In addition, the composite of death and intubation did not differ between the two types of noninvasive ventilation — about 11%.

However, secondary outcomes — including dyspnea, pulse rate, acidosis, and hypercapnia — favored noninvasive ventilation over standard therapy.

In Journal Watch Cardiology, Harlan M. Krumholz writes: "This trial provides little support for noninvasive ventilation as an initial approach to patients with acute heart failure." Meanwhile, J. Stephen Bohan concludes in Journal Watch Emergency Medicine: "Trying noninvasive ventilation ... is reasonable. If tolerated, treatment will improve symptoms and patient comfort."

LINK(S):

NEJM article (Free abstract; full text requires subscription)

Journal Watch Cardiology summary (Free)

Journal Watch Emergency Medicine summary (Free)

Published in Physician's First Watch July 10, 2008