This Article Full Text Full Text (PDF) All Versions of this Article: chest.07-1058v1 132/6/1804    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Ferrari, G. Articles by Navalesi, P. Search for Related Content PubMed PubMed Citation Articles by Ferrari, G. Articles by Navalesi, P.

Noninvasive Positive Airway Pressure and Risk of Myocardial Infarction in Acute Cardiogenic Pulmonary Edema^*

Continuous Positive Airway Pressure vs Noninvasive Positive Pressure Ventilation

^* From the High Dependency Unit (Drs. Ferrari, Olliveri, De Fillippi, Aprà, Converso, and Boccuzzi), Ospedale San Giovanni Bosco, Torino; Department of Medicine and Experimental Oncology (Dr. Milan), San Giovanni Battista Hospital, Torino; and Intensive Care Unit (Dr. Navalesi), SCDU Anestesia, Rianimazione e Terapia Intensiva-Azienda Ospedaliera "Maggiore della Carità," Università "A. Avogadro" del Piemonte Orientale, Novara, Italy.

Correspondence to: Giovanni Ferrari, MD, FCCP, High Dependency Unit, Ospedale San Giovanni Bosco, Piazza Donatore del Sangue 3 10154 Torino, Italy; e-mail: giovanni_ferrari{at}fastwebnet.it

Abstract

Background: The addition of both noninvasive continuous positive airway pressure (n-CPAP) or noninvasive intermittent positive pressure ventilation (n-IPPV) to medical treatment has been shown to improve the outcome of patients with acute cardiogenic pulmonary edema (ACPE). Previous studies indicated a potential risk of new-onset acute myocardial infarction (AMI) associated with the use of n-IPPV. Although further studies did not confirm this observation, a few recent metaanalyses could not eliminate all the doubts at this regards because of the paucity of data available and the presence of confounding factors. This study aims to assess whether the application of n-IPPV, as opposed to n-CPAP, increases the rate of AMI in ACPE patients.

Methods: Fifty-two patients with severe hypoxemia consequent to ACPE were randomized to receive n-CPAP (n = 27) or n-IPPV (n = 25) in addition to medical therapy. Patients with signs of acute coronary syndrome on hospital admission were excluded from the study. Cardiac markers, ECG, and clinical/physiologic parameters were assessed at study entry, after 30 and 60 min, and every 6 h for the first 2 days.

Results: No significant difference was observed in the rate of AMI (26.9% and 16% with n-CPAP and n-IPPV, respectively, p = 0.244). Rate of intubation (p = 0.481), death (p = 0.662), and hospital stay (p = 0.529) were not different between the two groups. Both techniques were effective in improving gas exchange and vital signs in patients with ACPE.

Conclusions: The AMI rate was not different with n-CPAP and n-IPPV, which resulted to be equally effective in the treatment of ACPE.

Trial registration: Clinicaltrials.gov Identifier: NCT00453947.

Key Words: continuous positive airway pressure • intermittent positive-pressure breathing • myocardial infarction • pulmonary edema • randomized controlled trial