• Semir Nouira, Riadh Boukef, Wahid Bouida, Wieme Kerkeni, Kaouther Beltaief, Hamdi Boubaker, Latifa Boudhib, Mohamed Habib Grissa, Mohamed Naceur Trimech, Hamadi Boussarsar, Mehdi Methamem, Soudani Marghli, and Mondher Ltaief.
• Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia. semir.nouira@rns.tn
• Intensive Care Med. 2011 Feb 1;37(2):249-56.

IntroductionNoninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) are both advocated in the treatment of cardiogenic pulmonary edema (CPE); however, the superiority of one technique over the other has not been clearly demonstrated. With regard to its physiological effects, we hypothesized that NIPSV would be better than CPAP in terms of clinical benefit.MethodsIn a prospective, randomized, controlled study performed in four emergency departments, 200 patients were assigned to CPAP (n = 101) or NIPSV (n = 99). Primary outcome was combined events of hospital death and tracheal intubation. Secondary outcomes included resolution time, myocardial infarction rate, and length of hospital stay. Separate analysis was performed in patients with hypercapnia and those with high B-type natriuretic peptide (>500 pg/ml).ResultsHospital death occurred in 5 (5.0%) patients receiving NIPSV and 3 (2.9%) patients receiving CPAP (p = 0.56). The need for intubation was observed in 6 (6%) patients in the NIPSV group and 4 (3.9%) patients in the CPAP group (p = 0.46). Combined events were similar in both groups. NIPSV was associated to a shorter resolution time compared to CPAP (159 ± 54 vs. 210 ± 73 min; p < 0.01), whereas the incidence of new myocardial infarction was not different between both groups. Similar results were found in hypercapnic patients and those with high B-type natriuretic peptide.ConclusionsDuring CPE, NIPSV accelerates the improvement of respiratory failure compared to CPAP but does not affect primary clinical outcome either in overall population or in subgroups of patients with hypercapnia or those with high B-type natriuretic peptide.

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