IMPACT OF CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) NONINVASIVE VENTILATION COMPARED TO CONVENTIONAL OXYGEN THERAPY IN ACUTE CARDIOGENIC PULMONARY EDEMA: A LITERATURE REVIEW
DOI:
https://doi.org/10.56238/arev7n11-004Keywords:
Cardiogenic Acute Pulmonary Edema (CAPE), Noninvasive Ventilation (NIV), CPAP, Oxygen Therapy, IntubationAbstract
Cardiogenic acute pulmonary edema (CAPE) is a classic clinical emergency with high morbidity and mortality. Conventional oxygen therapy often fails to prevent endotracheal intubation, thereby increasing complications. This literature review aimed to analyze the impact of noninvasive ventilation (NIV) using continuous positive airway pressure (CPAP) compared to oxygen therapy in reversing dyspnea and tachypnea, and in reducing the need for intubation in patients with CAPE. The objective was to evaluate the efficacy and safety of CPAP in this context. A systematic search was conducted in the PubMed, SciELO, and Google Scholar databases between August and October 2025, selecting 24 studies (meta-analyses, systematic reviews, randomized clinical trials, and clinical guidelines) according to strict inclusion criteria. The results demonstrated that CPAP promotes rapid improvement in dyspnea, oxygenation, and hemodynamic parameters within less than one hour, significantly reducing intubation rates (RR≈0.49; NNT≈13), without an increase in cardiac complications, although its effect on mortality remains uncertain (RR=0.65, low certainty). It is concluded that CPAP is a feasible, appropriate, and decisive intervention for ventilatory stabilization in CAPE, and its early implementation is recommended. Further research is essential to evaluate its efficacy across different subgroups and in comparison, with other therapies, such as high-flow nasal cannula.
Downloads
References
AMERICAN HEART ASSOCIATION (AHA); AMERICAN COLLEGE OF CARDIOLOGY (ACC); HEART FAILURE SOCIETY OF AMERICA (HFSA). 2022
AHA/ACC/HFSA guideline for the management of heart failure. Journal of the American College of Cardiology, v. 79, n. 17, p. e263–e421, 2022. DOI: https://doi.org/10.1016/j.jacc.2021.12.012
ASSOCIAÇÃO DE MEDICINA INTENSIVA BRASILEIRA (AMIB). Protocolo de sedação, analgesia e bloqueio neuromuscular durante a pandemia COVID-19. São Paulo: AMIB, 2020.
BERBENETZ, N. et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database of Systematic Reviews, v. 4, CD005351, 2019. DOI: 10.1002/14651858.CD005351.pub4. DOI: https://doi.org/10.1002/14651858.CD005351.pub4
BRAMBILLA, A. M.; PRINA, E.; FERRARI, G.; BOZZANO, V.; FERRARI, R.; GROFF, P.; PETRELLI, G.; SCALA, R.; CAUSIN, F.; NOTO, P.; BRESCIANI, E.; VOZA, A.;
ALIBERTI, S.; COSENTINI, R.; et al. Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: an Italian multicenter observational study. European Journal of Internal Medicine, v. 59, p. 21-26, Jan. 2019. DOI: https://doi.org/10.1016/j.ejim.2018.09.025
CHAWLA. R.; DIXIT, S.B. et al. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs. Indian Journal of Critical Care Medicine, v. 24, supl. 1, p. S61-S81, 2020. DOI: https://doi.org/10.5005/jp-journals-10071-G23186
DRKIĆ, T. J. et al. Impact of Continuous Positive Airway Pressure on Patient Outcomes in Acute Cardiogenic Pulmonary Edema within Physician-Led Prehospital Care. Medical Sciences, v. 13, n. 1, p. 5, 2025. DOI: 10.3390/medsci13010005. DOI: https://doi.org/10.3390/medsci13010005
EUROPEAN SOCIETY OF CARDIOLOGY (ESC). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, v. 42, n. 36, p. 3599–3726, 2021.
FREIRE, M. V. et al. Edema Agudo de Pulmão Cardiogênico: avaliação diagnóstica e evoluções terapêuticas – análise da literatura atual. Research, Society and Development, v. 14, n. 3, e9414348524, 2025. DOI: 10.33448/rsd-v14i3.48524. DOI: https://doi.org/10.33448/rsd-v14i3.48524
GRAY, A.; GOODACRE, S.; NEWBY, D. E. et al. Noninvasive ventilation in acute cardiogenic pulmonary edema (3CPO trial). New England Journal of Medicine, v. 359, n. 2, p. 142-151, 2008. DOI: 10.1056/NEJMoa0707992. DOI: https://doi.org/10.1056/NEJMoa0707992
LI, H. et al. A comparison of bilevel and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary edema. American Journal of Emergency Medicine, v. 31, n. 9, p. 1322-1327, 2013. DOI: https://doi.org/10.1016/j.ajem.2013.05.043
MASIP, J. et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA, v. 294, n. 24, p. 3124-3130, 2005. DOI: https://doi.org/10.1001/jama.294.24.3124
MORITZ, F.; BROUSSE, B.; GELLÉE, B.; CHAJARA, A.; L’HER, E.; HELLLOT, M.-F.; BÉNICHOU, J. Continuous positive airway pressure versus bilevel noninvasive ventilation in acute cardiogenic pulmonary edema: a randomized multicenter trial. Annals of Emergency Medicine, v. 50, n. 6, p. 666-675, 2007. doi: https://doi.org/10.1016/j.annemergmed.2007.06.488 DOI: https://doi.org/10.1016/j.annemergmed.2007.06.488
NERI, A. P.; SILVA, R. S. Ventilação não invasiva no edema agudo de pulmão cardiogênico: revisão de literatura. Journal of Specialized Nursing Care, v. 14, n. 2, p. 1-10, 2022. DOI: https://doi.org/10.52600/2965-0968.bjcmr.2023.1.Suppl.2.34
PARK, M.; SANGEAN, M. C.; VOLPE, M. S. et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Critical Care Medicine, v. 32, n. 12, p. 2407- 2415, 2004. DOI: 10.1097/01.ccm.0000147770.20400.10. DOI: https://doi.org/10.1097/01.CCM.0000147770.20400.10
PETER, J. V. et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema: a systematic review and meta-analysis. Critical Care, v. 10, n. 2, R69, 2006. DOI: https://doi.org/10.1186/cc4905
VITAL, F. M. et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database of Systematic Reviews, v. 5, CD005351, 2013. DOI: https://doi.org/10.1002/14651858.CD005351.pub3
WINCK, J. C. et al. Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Clinics, v. 61, n. 3, p. 247-252, 2006. DOI: https://doi.org/10.1590/S1807-59322006000300010
