Donnez-vous souvent de la ventilation positive aux patients avec un pH
à 7,35??
Je voudrais voir les résultats avec des patients avec un pH inférieur
à 7,25. Le résultat serait probablement beaucoup plus parlant.
Bernard
Le 08-09-02 à 10:00, Alain Vadeboncoeur a écrit :
FAscinant quand même!
ALain
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Sent: 2 septembre 2008 05:21
To: [EMAIL PROTECTED]
Subject: InfoPOEM: CPAP and NIPPV no better than O2 in acute
pulmonary edema (3CPO)
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CPAP and NIPPV no better than O2 in acute pulmonary edema (3CPO)
Clinical question
Does noninvasive ventilation improve outcomes in patients with acute
cardiogenic pulmonary edema?
Bottom line
In patients with acute cardiogenic pulmonary edema, continuous
positive airway pressure (CPAP) and noninvasive positive pressure
support (NIPPV) do not reduce mortality or the risk of requiring
intubation more than standard oxygen therapy. They may provide a
small benefit in terms of greater relief of dyspnea. (LOE = 1b)
Reference
Gray A, Goodacre S, Newby DE, et al, for the 3CPO Trialists.
Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl
J Med 2008;359(2):142-151.
Study design
Randomized controlled trial (nonblinded)
Funding
Government
Allocation
Concealed
Setting
Inpatient (any location)
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Synopsis
The optimal approach to noninvasive ventilation for patients with
acute cardiogenic pulmonary edema remains unclear, with only a few
small randomized controlled trials. CPAP provides the same level of
positive airway pressure throughout the respiratory cycle, while
NIPPV increases pressure more during inspiration than during
expiration. There are theoretical reasons to think that NIPPV may be
better, but it has also been associated with a greater risk of acute
myocardial infarction. In this study, 1069 adults with acute
cardiogenic pulmonary edema at 26 United Kingdom emergency
departments were randomized to receive oxygen therapy, CPAP, or
NIPPV. All patients had pulmonary edema on chest x-ray, a pH of less
than 7.35, and a respiratory rate greater than 20 breaths per
minute. Their mean age was 78 years and 57% were women. All patients
received the assigned treatment for at least 2 hours, with the
duration of further treatment determined by the treating physician.
Groups were balanced at the start of the study and analysis was by
intention to treat. Overall adherence to the assigned treatment was
good, although patients initially assigned to oxygen were more
likely to change therapy because of respiratory distress (8.4% vs
1.4% for CPAP and 3.4% for NIPPV; P < .001), while those assigned to
NIPPV were more likely to change therapy because of patient
discomfort (8.4% vs 5.2% for CPAP and 0.3% for oxygen; P < .001).
After 7 days, there was no significant difference between groups
regarding rates of mortality or need for intubation, or regarding
mortality at 30 days. Patients receiving CPAP or NIPPV had a greater
improvement on a 10-point dyspnea score than those receiving oxygen
alone (4.6 vs 3.9 points), but this difference is of questionable
clinical significance. There were also greater improvements in
arterial pCO2 and pH, but again the clinical significance is
uncertain.
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