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Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients

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Abstract

Objective

To compare the physiological effects and the clinical efficacy of continuous positive airway pressure (CPAP) vs standard medical treatment in elderly patients (≥75 years) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema.

Design

A prospective, randomized, concealed, and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general, and three teaching, hospitals.

Intervention

Patients were randomly assigned to receive standard medical treatment alone (n=46) or standard medical treatment plus CPAP (n=43).

Measurements

Improvement in PaO2/FIO2 ratio, complications, length of hospital stay, early 48-h and overall mortality, compared between the CPAP and standard treatment groups.

Results

Study groups were comparable with regard to baseline physiological and clinical characteristics (age, sex ratio, autonomy, medical history, cause of pulmonary edema). Within 1 h, noninvasive continuous positive airway pressure led to decreased respiratory rate (respiratory rate, 27±7 vs 35±6 breaths/min; p=0.009), and improved oxygenation (PaO2/FIO2, 306±104 vs 157±71; p=0.004) compared with baseline, whereas no differences were observed within the standard treatment group. Severe complications occurred in 17 patients in the standard treatment group, vs 4 patients in the noninvasive continuous positive airway pressure group (p=0.002). Early 48-h mortality was 7% in the noninvasive continuous positive airway pressure group, compared with 24% in the standard treatment group (p=0.017); however, no sustained benefits were observed during the overall hospital stay.

Conclusion

Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema, but only reduces early 48-h mortality.

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Acknowledgements

The authors are grateful to Mrs. M.-H. Lallier and I. Frachon from the Cellule de Recherche Biomédicale-CHU de Brest for their help in conducting the study. They also thank L. Brochard and F. Lemaire for their scientific assistance. This study was promoted by the Brest University Hospital. Technical support (material and ventilatory circuits) was provided by Allegiance SA (Paris, France).

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Authors and Affiliations

  1. Réanimation et Urgences Médicales, Centre Hospitalier Universitaire de la Cavale Blanche, 29609, Brest Cedex, France

    Erwan L’Her, Françoise Duquesne, Serge Renault & Jean-Michel Boles

  2. Service d’Hygiène et de Santé Publique, Hôpital Henri Mondor, Créteil, France

    Emmanuelle Girou

  3. Service d’Accueil et d’Urgences, Centre Hospitalier Intercommunal de Cornouailles, Quimper, France

    Xavier Donin de Rosiere

  4. Service d’Accueil et d’Urgences, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Place Alexis Ricordeau, Nantes, France

    Philippe Le Conte

  5. Service d’Accueil et d’Urgences, Centre Hospitalier Universitaire d’Angers, Angers, France

    Jean-Paul Allamy

Authors
  1. Erwan L’Her
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  2. Françoise Duquesne
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  3. Emmanuelle Girou
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  4. Xavier Donin de Rosiere
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  5. Philippe Le Conte
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  6. Serge Renault
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  7. Jean-Paul Allamy
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  8. Jean-Michel Boles
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Corresponding author

Correspondence to Erwan L’Her.

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L’Her, E., Duquesne, F., Girou, E. et al. Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients. Intensive Care Med 30, 882–888 (2004). https://doi.org/10.1007/s00134-004-2183-y

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  • DOI: https://doi.org/10.1007/s00134-004-2183-y

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