Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema

Crit Care Med. 2002 Nov;30(11):2457-61. doi: 10.1097/00003246-200211000-00009.


Objective: Continuous positive airway pressure (CPAP) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. However, we hypothesized that bilevel noninvasive positive-pressure ventilation (NPPV), which combines both inspiratory pressure support and positive expiratory pressure, would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP.

Design: Randomized crossover study.

Setting: Critical care unit, Raymond Poincaré Hospital.

Patients: Six consecutive patients with acute cardiogenic pulmonary edema.

Interventions: Patients were sequentially treated with 5 cm H2O CPAP, 10 cm H2O CPAP, and NPPV in a random order.

Measurements and main results: Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence. NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline (p <.05). There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP. NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index.

Conclusions: This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema. In addition, NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload, which suggests an improvement in cardiac performance.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Over Studies
  • Female
  • Heart Diseases / therapy*
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Positive-Pressure Respiration / methods*
  • Pulmonary Edema / therapy*
  • Respiratory Mechanics
  • Single-Blind Method
  • Statistics, Nonparametric