GW24-e1268 A comparison of bi-level and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary oedema; a systematic review

Objectives Whether bi-level positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary oedema (ACPO) remains uncertain. The aim of the meta-analysis was to assess potential beneficial and adverse effects of CPAP compared with BiPAP in patients with ACPO. Methods Randomised controlled trials (RCTs) comparing the treatment effects of BiPAP with CPAP were identified from electronic databases and reference lists from January 1966 to July 2012. Two reviewers independently assessed study quality. Data were combined using Review Manager 4.3. Both pooled effects and 95% confidence intervals were calculated. Results Twelve RCTs with a total of 1433 ACPO patients were included. The hospital mortality (relative risk [RR] 0.86, 95% confidence interval [CI] 0.65 -1.14; P = 0.46; I 2 = 0%) and need for requiring invasive ventilation (RR 0.89, 95% CI 0.57 -1.38; P = 0.64; I 2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. The occurrence of new cases of myocardial infarction (RR 0.95; 95% CI 0.77 -1.17; P = 0.53, I 2 = 0%) and length of hospital stay (RR 1.01, 95% CI -0.40 -2.41; P = 0.98; I 2 = 0%) were also not significantly different between the two groups. Conclusions There are no significant differences in clinical outcomes when comparing CPAP versus BiPAP. Based on the limited data available, there was an insignificant trend toward an increase in new onset acute myocardial infarction in patients treated with BiPAP.