Grupo de Estudio, Docencia e Investigación Clínica, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
J Card Fail. 2011 Oct;17(10):850-9. doi: 10.1016/j.cardfail.2011.05.010. Epub 2011 Jul 8.
The evidence of individual studies in acute cardiogenic pulmonary edema (ACPE) supporting noninvasive ventilation (NIV) is still inconclusive, particularly regarding noninvasive positive pressure ventilation (NIPPV).
We carried out a meta-analysis. We searched in the Embase, Medline, Cinahl, Dare, Coch, Central, and CNKI databases and congress abstracts for trials comparing continuous positive airway pressure (CPAP) or NIPPV with standard therapy (ST). To assess treatment effects, we carried out direct comparison using a random effects model and adjusted indirect comparison.
At total of 34 studies (3,041 patients) were included. In direct comparisons, both CPAP and NIPPV reduced the risk of death (relative risk [RR] 0.64, 95% CI 0.44-0.93; RR 0.80, 95% CI 0.58-1.10; respectively) compared with ST, although only CPAP had a significant effect. There were no significant differences between NIPPV and CPAP. Pooled results of direct and adjusted indirect comparisons showed that compared with ST, both CPAP and NIPPV significantly reduced mortality (RR 0.63, 95% CI 0.44-0.89; RR 0.73, 95% CI 0.55-0.97; respectively).
Our findings suggest that among ACPE patients, NIV delivered through either NIPPV or CPAP reduced mortality.
支持无创通气（NIV）治疗急性心源性肺水肿（ACPE）的个体研究证据仍不确定，尤其是无创正压通气（NIPPV）。
我们进行了一项荟萃分析。我们在 Embase、Medline、Cinahl、Dare、Coch、Central 和中国知网数据库以及会议摘要中检索了比较持续气道正压通气（CPAP）或 NIPPV 与标准治疗（ST）的试验。为了评估治疗效果，我们使用随机效应模型和调整后的间接比较进行了直接比较。
共纳入 34 项研究（3041 例患者）。直接比较显示，CPAP 和 NIPPV 均降低了死亡风险（相对风险 [RR] 0.64，95%CI 0.44-0.93；RR 0.80，95%CI 0.58-1.10；分别）与 ST 相比，尽管只有 CPAP 有显著效果。NIPPV 和 CPAP 之间没有显著差异。直接比较和调整后的间接比较的汇总结果表明，与 ST 相比，CPAP 和 NIPPV 均显著降低死亡率（RR 0.63，95%CI 0.44-0.89；RR 0.73，95%CI 0.55-0.97；分别）。
我们的研究结果表明，在 ACPE 患者中，通过 NIPPV 或 CPAP 进行的 NIV 可降低死亡率。
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