• Karim Chadda, Djillali Annane, Nicholas Hart, Philippe Gajdos, Jean Claude Raphaël, and Frédéric Lofaso.
• Service de Réanimation Médicale, Hôpital Raymond Poincaré, Gauches, France.
• Crit. Care Med. 2002 Nov 1;30(11):2457-61.

ObjectiveContinuous 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.DesignRandomized crossover study.SettingCritical care unit, Raymond Poincaré Hospital.PatientsSix consecutive patients with acute cardiogenic pulmonary edema.InterventionsPatients were sequentially treated with 5 cm H2O CPAP, 10 cm H2O CPAP, and NPPV in a random order.Measurements And Main ResultsCardiac 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.ConclusionsThis 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.

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