Efeitos da pressão positiva contínua e de dois níveis na via aérea em edema agudo de pulmão cardiogênico: uma revisão sistemática

INTRODUCTION: Acute cardiogenic lung edema (EAPC) represents an important cause of acute respiratory failure and can be attenuated with the installation of non-invasive mechanical ventilation (NIV). OBJECTIVE: To compare the use of continuous positive pressure (CPAP) and two-way positive airway pressure (BIPAP) in adult patients with acute pulmonary edema of pulmonary function, length of stay and complications, and dyspnea through a systematic review. METHODOLOGY: Systematic review of randomized controlled trials (RCTs) performed by two independent reviewers, as recommended by the PRISMA platform, in the PubMed and Cochrane Library databases. Original studies using CPAP and BIPAP were used in patients with acute cardiogenic lung edema published in English. The PEDro Scale was used to analyze the methodological quality of the studies and Cochrane Collaboration. RESULTS: We included 13 articles, published between 1997 and 2014. CPAP levels ranged from 5 to 20 cmH 2 O in the studies, and BIPAP presented positive inspiratory pressure (IPAP) between 8 and 20 cmH 2 O and positive expiratory pressure (EPAP) between 3 and 10 cmH 2 O. The studies presented CPAP and BIPAP without statistically significant difference for the improvement of the pulmonary function (FR, PaO 2 and PaCO 2 ), permanence of hospitalization, mortality rates, intubation and acute myocardial infarction (AMI); as equally effective modalities. CONCLUSION: CPAP and BIPAP guarantee the same effects to improve pulmonary function, does not maintain relation with the permanence of hospitalization and complications, namely: mortality, intubation and AMI, and improve dyspnea.