Skip Navigation

European Heart Journal 2002 23(17):1379-1386; doi:10.1053/euhj.2001.3156
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (27)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kelly, C.A.
Right arrow Articles by Douglas, N.J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kelly, C.A.
Right arrow Articles by Douglas, N.J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. Effects on plasma brain natriuretic peptide concentrations

C.A. Kellya,f1, D.E. Newbyb, T.A. Mcdonaghc, T.W. Mackaya, J. Barra, N.A. Boonb, H.J. Dargiec and N.J. Douglasa

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.

References

  1. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94:281–288[CrossRef][Web of Science][Medline]
  2. Stauffer JL, Olsen DE, Petty TL. Complications and consequences of endotracheal intubation and tracheostomy: a prospective study of 150 critically ill patients. Am J Med. 1980;70:65–76
  3. Katz JA, Marks JD. Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. Anesthesiology. 1985;63:598–607[Web of Science][Medline]
  4. Naughton MT, Rahman A, Hara K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressure in patients with congestive heart failure. Circulation. 1995;91:1725–1731[Abstract/Free Full Text]
  5. Lenique F, Habis M, Lofaso F, Dubois-Rande J-L, Harf A, Brochard L. Ventilatory and haemodynamic effects of CPAP in left heart failure. Am J Respir Crit Care Med. 1997;155:500–505[Abstract]
  6. Baratz DM, Westbrook PR, Shah PK, Mohsenifar Z. Effect of nasal CPAP on cardiac output and oxygen delivery in patients with congestive heart failure. Chest. 1992;103:1397–1401
  7. Bernsten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med. 1991;325:1825–1830[Abstract]
  8. Rasanen J, Heikkila J, Downs J, Nikki P, Vaisanen I, Viitanen A. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol. 1985;55:296–300[CrossRef][Web of Science][Medline]
  9. Lin M, Yang YF, Chiang HT, Chang M-S, Chiang BN, Cheitlin MD. Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema: short term results and long term follow up. Chest. 1995;107:1379–1386[Abstract/Free Full Text]
  10. Mehta S, Jay GD, Woolard RH. Randomized, prospective trial of bi-level versus continuous positive airway pressure in acute pulmonary oedema. Crit Care Med. 1997;25:620–628[CrossRef][Web of Science][Medline]
  11. Masip J, Betbese AJ, Paez J. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet. 2001;356:2126–2132
  12. Levine TB, Francis GS, Goldsmith SR, Simon AB, Cohn JN. Activity of the sympathetic nervous system and renin-angiotensin system assessed by plasma hormone levels and their relation to haemodynamic abnormalities in congestive heart failure. Am J Cardiol. 1982;49:1659–1666[CrossRef][Web of Science][Medline]
  13. Francis GS, Benedict C, Johnstone DE. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. Circulation. 1990;82:1724–1729[Abstract/Free Full Text]
  14. Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. Circulation. 1990;82:1730–1736[Abstract/Free Full Text]
  15. Yasue H, Yoshimura M, Sumida H. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation. 1994;90:195–203[Abstract/Free Full Text]
  16. Wei C-M, Heublein DM, Perella MA. Natriuretic peptide system in human heart failure. Circulation. 1993;88:1004–1009[Abstract/Free Full Text]
  17. Yu CM, Sanderson JE. Plasma brain natriuretic peptide—an independent predictor of cardiovascular mortality in acute heart failure. Eur J Heart Failure. 1999;1:59–65[Abstract/Free Full Text]
  18. Tsutamoto T, Wada A, Maeda K. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation. 1997;96:509–516[Abstract/Free Full Text]
  19. Heublin DM, Heser DW, Edwards BS. N-terminal (1-25) atrial natriuretic factor in human congestive heart failure: a marker for endogenous secretion. J Am Coll Cardiol. 1989;13:9A
  20. Goldstein DS, Feuerstein G, Kopin IJ, Keiser HR. Validity and reliability of liquid chromatography with electromechanical detection for measuring plasma levels of norepinephrine and epinephrine in man. Life Sci. 1981;28:467–475[CrossRef][Web of Science][Medline]
  21. Bellenger NG, Burgess MI, Ray SG. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J. 2000;21:1387–1396[Abstract/Free Full Text]
  22. Kelly C, Newby DE, Boon NA, Douglas NJ. Support ventilation versus conventional oxygen. Lancet. 2001;357:1125–1127[Web of Science][Medline]
  23. Sacchetti AD, Harris RH, Paston C, Hernandez Z. Bi-level positive airway pressure support system use in acute congestive heart failure: preliminary case series. Acad Emerg Med. 1995;2:714–718[Web of Science][Medline]
  24. Pollack CV, Torres MT, Alexander L. Feasibility study of the use of bilevel positive airway pressure for respiratory support in the emergency department. Ann Emerg Med. 1996;27:189–192[Web of Science][Medline]
  25. Kelly AM, Bau S, Georgakos C, Rosengarten P. Experience with the use of continuous positive airway pressure (CPAP) therapy in the emergency management of acute severe cardiogenic pulmonary oedema. Aust NZ J Med. 1997;27:319–322[Web of Science][Medline]
  26. Sharon A, Shpirer I, Kaluski E. High-dose intravenous isosorbide dinitrate is safer than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol. 2000;36:832–837[Abstract/Free Full Text]
  27. Takeda S, Takano T, Ogawa R. The effect of nasal continuous positive airway pressure on plasma endothelin-1 concentrations in patients with severe cardiogenic pulmonary edema. Anesth Analg. 1997;84:1091–1096[Abstract]
  28. Rusterholz T, Kempf J, Berton C. Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema. Intensive Care Med. 1999;25:21–28[CrossRef][Web of Science][Medline]
  29. Qi W, Kjekshus J, Hall C. Differential responses of plasma atrial and brain natriuretic peptides to acute alteration in atrial pressure in pigs. Scand J Clin Lab Invest. 2000;60:55–63[CrossRef][Web of Science][Medline]
  30. Lazzeri C, Franchi F, Porciani C. Systemic hemodynamics and renal function during brain natriuretic peptide infusion in patients with essential hypertension. Am J Hypertens. 1995;8:799–807[CrossRef][Web of Science][Medline]
  31. Motwani JG, McAlpine H, Kennedy N, Struthers AD. Plasma brain natriuretic peptide as an indicator for angiotensin-converting-enzyme inhibition after myocardial infarction. Lancet. 1993;341:1109–1113[CrossRef][Web of Science][Medline]
  32. Omland T, Aakvaag A, Bonarjee VVS. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long term survival after acute myocardial infarction. Circulation. 1996;93:1963–1969[Abstract/Free Full Text]
  33. Sumida H, Yasue H, Yoshimura M. Comparison of secretion pattern between A-type and B-type natriuretic peptides in patients with old myocardial infarction. J Am Coll Cardiol. 1995;25:1105–1110[Abstract]
  34. Morita E, Yasue H, Yoshimura M. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation. 1993;88:82–91[Abstract/Free Full Text]
  35. Cohn JN, Levine TB, Olivari MT. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–823[Abstract]
  36. Missouris CG, Grouzmann E, Buckley MG, Barron J, MacGregor GA, Singer DR. How does treatment influence endocrine mechanisms in acute severe heart failure? Effects on cardiac natriuretic peptides, the renin system, neuropeptide Y and catecholamines. Clin Sci. 1998;94:591–599[Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Emerg. Med. J.Home page
W Dieperink, E E M Weelink, I C C van der Horst, R de Vos, T Jaarsma, L P H J Aarts, F Zijlstra, and M W N Nijsten
Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure
Emerg. Med. J., February 1, 2009; 26(2): 141 - 144.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
For questions on page
Emerg. Med. J., January 1, 2009; 26(1): 75 - 75.
[Full Text] [PDF]

Home page
 NEJMHome page
A. Gray, S. Goodacre, D. E. Newby, M. Masson, F. Sampson, J. Nicholl, and the 3CPO Trialists
Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema
N. Engl. J. Med., July 10, 2008; 359(2): 142 - 151.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
J. Masip, M. Roque, B. Sanchez, R. Fernandez, M. Subirana, and J. A. Exposito
Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema: Systematic Review and Meta-analysis
JAMA, December 28, 2005; 294(24): 3124 - 3130.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
R Agarwal, A N Aggarwal, D Gupta, and S K Jindal
Non-invasive ventilation in acute cardiogenic pulmonary oedema
Postgrad. Med. J., October 1, 2005; 81(960): 637 - 643.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Endorsed by the European Society of Intensive Care, Authors/Task Force Members, M. S. Nieminen, M. Bohm, M. R. Cowie, H. Drexler, G. S. Filippatos, G. Jondeau, Y. Hasin, J. Lopez-Sendon, et al.
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology
Eur. Heart J., February 2, 2005; 26(4): 384 - 416.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
F. Mojoli, L. Monti, M. Zanierato, C. Campana, S. Mediani, L. Tavazzi, and A. Braschi
Respiratory fatigue in patients with acute cardiogenic pulmonary edema
Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F74 - F80.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
S D Crane, M W Elliott, P Gilligan, K Richards, and A J Gray
Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema
Emerg. Med. J., March 1, 2004; 21(2): 155 - 161.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
H. Smithline, N. Kucher, G. Printzen, T. Doernhoefer, S. Windecker, B. Meier, and O. M. Hess
Use of Natriuretic Peptides in Guiding Treatment Decisions for Acute Pulmonary Embolism * Response
Circulation, September 30, 2003; 108 (13): e93 - e93.
[Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
CPAP for Pulmonary Edema
Journal Watch Emergency Medicine, November 13, 2002; 2002(1113): 5 - 5.
[Full Text]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (27)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kelly, C.A.
Right arrow Articles by Douglas, N.J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kelly, C.A.
Right arrow Articles by Douglas, N.J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?