What is the efficacy of noninvasive ventilation (NIV) using bilevel positive airway pressure (BiPAP) for cardiogenic pulmonary edema and congestive heart failure (CHF)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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The experience with noninvasive ventilation provided using BiPAP or pressure support modalities, however, has been mixed. Some investigators found no benefit with their applied noninvasive ventilation, and some noted more complications, specifically higher rates of myocardial infarction. Other investigators found greater benefit in symptom relief and oxygenation but no differences in intubation rates or mortality rates or benefits in a post hoc analysis involving hypercapnic patients. Meta-analyses do suggest a benefit with CPAP, with a risk reduction in intubation of 60% (RR, 0.40; 95% CI, 0.27-0.58) and a decrease in mortality rate of 47% (RR, 0.53; 95% CI, 0.35-0.81). Noninvasive ventilation has also demonstrated a risk reduction in intubation rates of 52% (RR, 0.48; 95% CI, 0.34-0.76), but not for mortality rates. No differences were noted when comparing CPAP and noninvasive ventilation. [24, 25]

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