Heart failure: pulmonary oedema: non-invasive pressure support ventilation reduced treatment failure

Clinical bottom line (level 1b)

  1. Patients with acute cardiogenic pulmonary oedema who received non-invasive pressure support ventilation compared with conventional oxygen therapy were less likely to require endotracheal intubation (NN T = 4 at 10 hours) .
Masip et al: Lancet 2000; 356 : 2126-2132
Expires November 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: intensive care unit, university hospital, Spain

40 patients with acute cardiogenic pulmonary oedema (confirmed clinically and on chest X-ray)

Excluded if
  • cardiogenic shock (systolic bp < 90 mmHg)
  • severe acute or chronic airflow obstruction without evidence of cardiogenic pulmonary oedema
  • severe chronic renal failure (serum creatinine > 265 micromol/l)
  • any neurological impairment preventing adherence to protocol
  • acute myocardial infarction requiring thromobolysis
  • evidence of pneumonia
  • immediate need for intubation
  • absence of pulmonary oedema on first chest X-ray
  • no evidence of dyspnoea

    Control Group: (n = 20, 18 analysed): conventional oxygen therapy
    Experimental Group: (n = 20, 19 analysed): non-invasive pressure support ventilation

    93% followed for 10 hours
    Outcome notes:
    • treatment failure requiring endotracheal intubation : cardiac or respiratory arrest; or refractory and progressive hypoxia (SaO2 < 80%) with clinical signs of muscle fatigue

    The evidence

    Outcome Time to outcome CER EER RRR
    (95% CI)    		 ARR
    (95% CI)    		 NN T
    (95% CI)
    treatment failure requiring endotracheal intubation 10 hours 6
    (33.3%)    		 1
    (5.26%)    		 84%
    (-19% to 98%)    		 28.1%
    (4.09% to 52.1%)    		 4
    (2 to 24)

    Comments

    1. The small size of the study increases the risk of a false positive result.
    2. This technique needs to be compared against CPAP.

    Citation

    1. Masip J, Betbese AJ, Paez J, et al: non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary odema: a randomised trial. Lancet 2000; 356 : 2126-2132
    Search Terms: ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient non-invasive pressure support ventilation
    Intervention or Exposure
    Outcome