Efficacy of noninvasive ventilation on in-hospital mortality in patients with acute cardiogenic pulmonary edema: a meta-analysis

Objective: To evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema (ACPE). Methods: We searched PubMed, Embase, Wanfang, CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE, which were reported from January 1980 to December 2012. Meta-analysis was performed with software of RevMan 5.1. Results: According to inclusive criteria and exclusion criteria, 35 randomized controlled trials with 3204 patients were enrolled for analyses. Meta-analysis of the trials showed that continuous positive airway pressure (CPAP) reduced in-hospital mortality by 43% (RR=0.57, 95% CI 0.43-0.75, P<0.01) and bilevel positive pressure ventilatio n(BiPAP) reduced mortality by 31% (RR=0.69,95% CI 0.51-0.94, P=0.02) compared with standard therapy. There were no significant differences in in-hospital mortality between BiPAP and CPAP (RR=1.09, 95% CI 0.80-1.49, P=0.57) and myocardial infarction rate (BiPAP vs. CPAP: RR=1.20, 95% CI 0.95-1.52, P=0.12; BiPAP vs. standard therapy: RR=1.10, 95% CI 0.88-1.38, P=0.40). Conclusion: Noninvasive ventilation (BiPAP and CPAP) could reduce in-hospital mortality of adult patients with ACPE, which could be used as first-line management strategies for these patients.