Comparative study between bilevel non-invasive ventilation versus conventional oxygen therapy in management of acute cardiogenic pulmonary edema.

Abstract

Background:
Non-invasive ventilation (NIV) seems to be of benefit in the immediate management of cases
with acute cardiogenic pulmonary edema (ACPE). There is no obvious data about parameters that
forecast the use of non-invasive mechanical ventilation from the start among these cases. This study
aimed to assess the safety and efficiency of Bi-level NPPV compared with the standard oxygen therapy
among adult cases with ACPE, moreover to recognize the factors that favor NIV use from the start.
Methods:
A prospective randomized study includin 100 cases diagnosed with acute cardiogenic
pulmonary edema (ACPE). Patients were randomized into two groups. Group I: Fifty patients received
bi-level ventilation or transferred from O2 to NIV plus anti-failure measures. Group II: Fifty patients
received standard face mask oxygen therapy plus anti-failure measures.
Results:
We identified several factors to predict the use of BiPAP in the study population such as
APACHE II score >20, LVEF ≤50, PASP>48, PH ≤7.18, SO2 ≤ 82%, PO2 ≤ 55, HCO3 ≤13, and
hospital stay >12days. APATCHE II score at a cutoff value >20, had the highest sensitivity and
Specificity (95,100% respectively) with the AUC (0.97).
Conclusion:
APACHE II score > 20, Left ventricular ejection fraction, pulmonary artery systolic pressure,
and ABG were the most factors that forecast the need for use of BiPAP from the start in management
of ACPE.