Meta-Analysis On The Efficacy Of Two Non-Invasive Positive Pressure Ventilation Modes In Acute Cardiogenic Pulmonary Edema

Objective:To assess the efficacy of bilevel positive airway pressure(BiPAP)compared with continuous positive airway pressure(CPAP)in patients with acute cardiogenic pulmonary edema(ACPE).Methods:We searched electronic databases of CNKI,Wangfang,VIP,PubMed,the Cochrane Library and EMbase,up to February 2019.The corresponding clinical randomized controlled trials(RCTs)were selected based on the inclusion and exclusion criteria.Data was checked and entered into the Review Manager 5.3 for further analysis.Results:24 randomized controlled trials were considered.The results are as follows.Compared with CPAP,BiPAP improved Respiration rates [MD=-2.98,95% CI(-4.62,-1.34),P=0.00004],pH [MD=0.03,95%CI(0.01,0.04),P=0.0009],Partial carbon dioxide pressures [SMD=-0.40,95%CI(-0.73,-0.06),P=0.02].The mortality [RR=1.08,95%CI(0.83,1.39),P=0.57] and the intubation rates [RR=1.29,95%CI(0.92,1.81),P=0.14] were not significantly different between patients treated with CPAP and those treated with BiPAP.This conclusion is also applicable to patients with hypercapnia for mortality [RR=1.20,95%CI(0.60,2.41),P=0.61] and the intubation rates [RR=1.04,95%CI(0.56,1.92),P=0.91].The occurrence of myocardial infarction [RR=1.08,95%CI(0.86,1.36),P=0.49] were also not significantly different between BiPAP and CPAP groups.A non-significant trend towards reduced length of hospital stay [MD=-0.27,95%CI(-1.40,0.85),P=0.63] and length of ICU stay[MD=-4.05,95%CI(-9.79,1.70),P=0.17] were seen in the comparison between BiPAP and CPAP.Based on the limited data available,there was no significant difference between BiPAP and CPAP groups in the occurrence of complication [RR=0.95,95 %CI(0.41,2.24),P=0.91],intolerance [RR=1.15,95%CI(0.16,8.03),P=0.89],abdominal distension [RR=1.26,95%CI(0.53,3.00),P=0.60],Facial discomfort [RR=0.83,95 % CI(0.31,2.25),P=0.72],drymouth and throat [RR=2.29,95%CI(0.58,9.08),P=0.24].Conclusion:Both BiPAP and CPAP are important treatment for acute cardiac pulmonary edema,and there is no significant difference in efficacy between them.Careful use of BiPAP in patients with hypercapnia is beneficial to relieve respiratory distress and improve PH and partial carbon dioxide pressure without increasing myocardial infarction rate.CPAP has the advantages of convenience and easy user operations,so it is more beneficial to popularize at grass-roots hospitals.