the role of noninvasive ventilation in acute cardiogenic pulmonary edema无创通气的作用在急性心原性肺水肿.pdfVIP

Salman et al. Critical Care 2010, 14:303 /content/14/2/303 J O U R N A L C LU B C R I T I Q U E The role of noninvasive ventilation in acute cardiogenic pulmonary edema 1 2 3 Ashar Salman, Eric B Milbrandt and Michael R Pinsky University of Pittsburgh Department of Critical Care Medicine: Evidence-Based Medicine Journal Club, edited by Eric B Milbrandt Expanded Abstract Citation Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J: Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008, 359:142-151 [1]. Background Noninvasive ventilation (NIV) (continuous positive airway pressure [CPAP] or noninvasive intermittent positive- pressure ventilation [NIPPV]) appears to be of benei t in the immediate treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality. Methods Objective: To determine whether noninvasive ventilation reduces mortality and whether there are important dif erences in outcome associated with the method of treatment (CPAP or NIPPV). Design: Open, prospective, randomized controlled trial. Setting: 26 emergency departments in hospital in the UK between July 2003 and April 2007. Subjects: 1069 patients age >16 years with a clinical diagnosis of acute cardiogenic pulmonary edema, as determined by chest radiograph, respiratory rate >20 breaths/min, and arterial pH<7.35. Exclusion criteria included a requirement for a lifesaving or emergency intervention, inability to give consent, or previous recruitment in the trial. Intervention: All patients received standard concomitant therapy. Patients were randomly assigned to standard oxygen therapy (up to 15 liters per minute via face mask), CPAP (5 to 15 cm of water), or NIPPV (inspiratory pressure, 8 to 20 cm of water; expiratory pressure, 4 to 10 cm of water). Outcomes: The primary end point for the comparison betw