Comparison of Bilevel and Continuous Positive Airway Pressure Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Acute cardiogenic pulmonary edema (ACPE) is one of the most common emergency medical conditions leading to hospitalization, with the associated higher rate of mortality, especially when it is coupled with acute myocardial infarction (AMI (. As many patients with ACPE respond rapidly to standardized medical treatment includes oxygen, diuretics, and vasodilators that could improve the symptoms. However, a significant number of patients required endotracheal intubation and ventilation, with its associated potential for complications. Over the past two decades, application of noninvasive ventilation(NIV) either with continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (Bi-PAP) has been suggested in association with the standardized medical treatment as an effective approach to treat ACPE. These due to augmentation of cardiac output and oxygen delivery, improved function residual capacity and respiratory mechanism, reduced effort in breathing, and decreased left ventricular preload and after load. Most studies evaluating CPAP and Bi-PAP have variable conclusions. As most of these studies were case series, and small, randomized trials, with considerable variation in study populations, the type of ventilation intervention, concomitant therapies, and outcome measurements. Moreover, the results from these studies are inconsistent. In addition, there are no or few clinical studies that investigated the role of NIV on ACPE in emergency departments in Egypt. Therefore, the current study was conducted to compare the efficacy of CPAP, Bi-PAP, and standard oxygen therapy on blood gases and vital signs in patients with ACPE, and to investigate whether either CPAP or Bi-PAP would cause improvement in endotracheal intubation and mortality rates.