Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema
Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema
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DOI：
10.1097/01.ccm.0000147770.20400.10
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发表时间：
2004-12-01
影响因子：
8.8
通讯作者：
Lorenzi-Filho, G
中科院分区：
文献类型：
--
作者：
Park, M;Sangean, MC;Lorenzi-Filho, G
客观，比较氧气、持续气道正压通气（CPAP）和双水平气道正压通气（bilevel-PAP）对急性心源性肺水肿患者气管插管率的影响。设计：随机对照试验。设置：三级医院急诊室。患者：我们将80例严重心源性急性肺水肿患者随机分为三个治疗组。随机分组后对患者进行60天的随访。面罩、CPAP和双水平PAP给氧。测量和主要结果。在前24小时内记录气管插管率以及生命体征和血气。在15天、60天和出院时评价死亡率。出院前评估呼吸支持相关并发症。与氧疗相比，CPAP或双水平PAP治疗可显著改善Pao（2）/Fio（2）比值、主观呼吸困难评分以及呼吸和心率。氧气组26例患者中有11例（42%）需要气管插管，但每个无创通气组27例患者中只有2例（7%）需要气管插管（p = 0.001）。CPAP或双水平PAP组的急性心肌梗死发生率没有增加。在15天的死亡率在氧气中高于CPAP或双水平PAP组（p <0.05）。死亡率出院组之间没有显着差异（p = 0.061）。结论：与氧疗相比，CPAP和bilevel-PAP导致相似的生命体征和动脉血气和气管插管率较低。无心脏缺血并发症与任何一种无创通气策略相关。
Objective., To compare the effects of oxygen, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel-PAP) on the rate of endotracheal intubation in patients with acute cardiogenic pulmonary edema.Design: Randomized, controlled trial.Setting: Tertiary hospital emergency room.Patients: We randomly assigned 80 patients with severe cardiogenic acute pulmonary edema into three treatment groups. Patients were followed for 60 days after the randomization.Interventions. Oxygen applied by face mask, CPAP, and bilevel-PAP.Measurements and Main Results., The rate of endotracheal intubation as well as vital signs and blood gases was recorded during the first 24 hrs. Mortality was evaluated at 15 days, at 60 days, and at hospital discharge. Complications related to respiratory support were evaluated before hospital discharge. Treatment with CPAP or bilevel-PAP resulted in significant improvement in the Pao(2)/Fio(2) ratio, subjective dyspnea score, and respiratory and heart rates compared with oxygen therapy. Endotracheal intubation was necessary in 11 of 26 patients (42%) in the oxygen group but only in two of 27 patients (7%) in each noninvasive ventilation group (p = .001). There was no increase in the incidence of acute myocardial infarction in the CPAP or bilevel-PAP groups. Mortality at 15 days was higher in the oxygen than in the CPAP or bilevel-PAP groups (p < .05). Mortality up to hospital discharge was not significantly different among groups (p = .061).Conclusions: Compared with oxygen therapy, CPAP and bilevel-PAP resulted in similar vital signs and arterial blood gases and a lower rate of endotracheal intubation. No cardiac ischemic complications were associated with either of the noninvasive ventilation strategies.