Chest
ReviewsThe Effect of Positive Pressure Airway Support on Mortality and the Need for Intubation in Cardiogenic Pulmonary Edema: A Systematic Review
Section snippets
Search Strategy
We used a number of search strategies to identify the relevant literature, including computerized literature searches of the National Library of Medicine's MEDLINE from 1983 to June 1997, using the key words pulmonary edema (therapy) and respiratory insufficiency (therapy) separately, with and without positive pressure respiration. These searches were limited to studies on humans and those published in English. Bibliographies of all selected articles and review articles were reviewed for other
Search and Study Selection
A total of 497 potentially relevant articles were identified using the search strategy described. Of these, only three randomized trials fulfilled all four selection criteria for studies comparing CPAP with standard therapy1, 2, 3 (Table 1). Reasons for exclusion of others were: nonrandomized clinical trials (n = 466), alternative study population (patients other than those with cardiogenic pulmonary edema) (n = 436), crossover trial (n = 1), and one study in which the patients may have been
DISCUSSION
From our systematic review of the literature, we conclude that the use of CPAP by face mask in patients with cardiogenic pulmonary edema and respiratory distress may decrease the need for endotracheal intubation. The three randomized controlled trials suggest a trend toward a decrease in hospital mortality in patients treated with CPAP; however, the 95% CI does not allow the exclusion of harm.1, 2, 3 The only study examining the impact of CPAP on left ventricular function found no difference
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Supported by the Richard Ivey Critical Care Trauma Center, London Health Sciences Centre, Victoria Campus, and the Program of Critical Care Medicine, University of Western Ontario, London, ON, Aberdeen Medical School. Dr. Keenan is supported by a Canadian Lung Association/Medical Research Council Fellowship. Dr. Cook is a Career Scientist of the Ontario Ministry of Health