Copyright © 2002 by the European Society of Cardiology.
Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. Effects on plasma brain natriuretic peptide concentrations
a Department of Respiratory Medicine, Royal Infirmary, Edinburgh, Scotland, U.K.
b Department of Cardiology, Royal Infirmary, Edinburgh, Scotland, U.K.
c Clinical Research Initiative in Heart Failure, Western Infirmary, Glasgow, Scotland, U.K.
revised December 3, 2001; accepted December 4, 2001
Abstract
Aims The study aim was to compare the effects of continuous positive airway pressure (CPAP) on clinical outcomes and plasma neurohormonal concentrations in patients with acute pulmonary oedema.
Methods and Results In addition to standard therapy, 58 consecutive patients were randomized to receive 60% inhaled oxygen with or without CPAP at 7·5cmH2O pressure. Clinical variables, symptoms and oxygenation were monitored and plasma epinephrine, norepinephrine and brain natriuretic peptide (BNP) concentrations estimated at 0, 1, 6 and 24h. CPAP was associated with less breathlessness at 1h (P<0·001), no treatment failures and more rapid resolution in respiratory rate (P<0·001), heart rate (P<0·001) and acidosis (P<0·005). Length of hospital stay was similar but there was a trend for a reduction in overall hospital mortality in the CPAP group (0·10>P>0·05). Plasma BNP concentrations rose progressively (P<0·001) before falling below admission concentrations at 24h. Plasma neurohumoral concentrations were unaffected by CPAP treatment but were elevated in patients who died or had acute myocardial infarction.
Conclusion CPAP produces a more rapid clinical and symptomatic improvement in patients with acute pulmonary oedema, particularly within the first hour. CPAP is a useful adjunctive treatment in the early management of acute heart failure. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Heart failure, ventilation, natriuretic peptides, oedema, oxygen
f1 Correspondence: Dr Catherine Kelly, Acute Medicine Directorate, Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW, Scotland, U.K.
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