Bi-level Positive Airway Pressure (BiPAP) ventilation vs Continuous Positive Airway Pressure (CPAP) ventilation in acute cardiogenic pulmonary oedema in the emergency department; a study conducted in two hospitals in Sri Lanka

Introduction: Acute pulmonary oedema is a life-threatening condition, and some patients require noninvasive ventilation such as continuous positive airway pressure (CPAP) ventilation and bi-level positive airway pressure (BiPAP) ventilation for improving alveolar ventilation and haemodynamic stability, thus, improving pulmonary oedema. This study aims to determine the efficacy and suitability of the CPAP vs. BiPAP ventilation in patients with acute pulmonary oedema following acute heart failure.
Methods: The study was conducted as a randomized prospective clinical trial at the emergency treatment unit of the National Hospital of Sri Lanka and Base Hospital, Panadura. Group A patient received pressure limits of IPAP-8 -20 cm H₂O, EPAP-4-10 cm H₂O and Group B received CPAP 10 - 15 cm H₂O and oronasal mask is used. Patients who do not tolerate CPAP were changed to BiPAP.
Results: Our study demonstrated that in addition to the standard medical care, after 2 hours of treatment, both CPAP and BiPAP improve vital parameters, oxygenation / blood gases, and ameliorate respiratory distress, effectively managing acute pulmonary oedema. A few patients (5.8%) stated that Non-Invasive Ventilation (NIV) is quite difficult to tolerate, but more than 60% of patients agreed that NIV was given less discomfort for them. However, patients receiving BiPAP demonstrated higher heart rate (102 ± 9.282) than the CPAP group 84 ± 13.326 at the end of treatment.
Conclusions: At the end of the treatment, both CPAP and BiPAP treatment modalities are capable of improving vital parameters and respiratory distress even though BiPAP group demonstrated higher heart rate at the end of treatment. However, the study does not demonstrate any significant difference of clinical benefit of BiPAP vs CPAP.