flávia maria ribeiro vital efetividade e segurança da - Unifesp

Abstract
Context: Noninvasive positive-pressure ventilation has been widely used to alleviate
signs and symptoms of respiratory distress due to several causes. It prevents alveolar
collapse and helps to redistribute intra-alveolar fluid, improving pulmonary compliance
and reducing respiratory work. Objectives: To determine the effectiveness and safety
of noninvasive positive pressure ventilation (CPAP and NPPV bi-level) compared with
standard medical care for treatment of cardiogenic pulmonary edema. Data Sources:
We performed a comprehensive search of 6 electronic databases in April of 2005.
Additionally, we reviewed the bibliographies of all included studies and contacted your
authors, experts, equipment manufacturers, and the Heart Group of Cochrane
Collaboration. No language restrictions were applied. Study Selection: We selected
blinded or unblinded randomized or quasi-randomized clinical trials evaluating adult
patients with acute or acute-on-chronic cardiogenic pulmonary edema and reporting
any: of hospital mortality, endotracheal intubation rate, hospital and intensive care unit
length of stay, incidence of acute myocardial infarction, arterial blood gases and pH
alteration and vital signs alteration. Data Extraction: Two authors independently
selected articles meeting the inclusion criteria, assessed study quality with emphasis on
allocation concealment, intention-to-treat analysis and loss to follow-up. Data extraction
was undertaken through a standardized form. Results: We included 21 studies
involving 1071 participants. Use of noninvasive ventilation led to significant reductions
in hospital mortality [Relative Risk (RR) 0.64; 95% Confidence Interval (CI) 0.47, 0.87],
endotracheal intubation rate (RR 0.53; 95%IC 0.35, 0.82) and intensive care unit length
of stay [weighted mean difference (WMD) –1.07 days; 95%IC -1.60,-0.53]. We noted
non significant differences in the incidence of acute myocardial infarction during (RR
1.23; 95%IC 0.78, 1.93) or after noninvasive ventilation (RR 1.08; 95%IC 0.11, 10.23),
side-effects and in hospital length of stay. Further led to significant improvement in
respiratory (WMD -2.63 rpm; 95%IC -3.67, -1.59) and cardiac rate (WMD -4.63 bpm;
95%IC -9.11, -0.15) after one hour intervention. Conclusion: Noninvasive positivepressure
ventilation is an effective and safe intervention for the treatment of adult
patients with cardiogenic pulmonary edema.