Todd Bolotin, Sachin Subedi, Sushil Dahal, Christina Walker, Kimberly Chung, Ava Martz, David Gemmel, Quincy Chopra, Chad Donley
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Abstract
Background: Morbidity and mortality in cardiogenic pulmonary edema have been reduced by noninvasive positive-pressure airway maneuvers. The value of continuous positive airway pressure (CPAP) for the treatment of high-altitude pulmonary edema (HAPE) is uncertain. The purpose of this study was to evaluate the efficacy and speed of CPAP for HAPE resolution.
Methods: A prospective, investigator-initiated, multicenter, randomized, double-blind controlled trial of high-flow oxygen with CPAP versus sham CPAP with high-flow oxygen (oxygen-only group) was conducted. Sixty-four dyspneic adults with maximum oxygen saturation < 85%, recent arrival at high altitude, and noncardiogenic pulmonary edema on chest radiography were randomized to receive CPAP treatment plus usual care or usual care (oxygen-only) delivered through a sham CPAP mask. The primary endpoint was the clinical resolution of HAPE.
Results: HAPE resolution in the CPAP plus high FiO2 group and the high flow oxygen alone group was similar. However, this finding should be interpreted cautiously due to this study being slightly underpowered. There was no significant difference in time to resolution (CPAP ~158 min vs. oxygen ~178 min, p = 0.297). Both therapies were effective, with a mean time to resolution of HAPE of approximately 2.5 to 3 h. No treatment-related adverse outcomes, intubations, or mortality were observed in either group.
Conclusion: Both CPAP with high-flow oxygen and high-flow oxygen alone are highly effective for the treatment of HAPE. CPAP conferred no improvement in the time to resolution of HAPE. High-flow oxygen therapy requires significantly less resource utilization for similar benefits in the treatment of HAPE.
背景：无创气道正压通气可以降低心源性肺水肿的发病率和死亡率。持续气道正压通气（CPAP）治疗高原肺水肿（HAPE）的价值尚不确定。本研究的目的是评价CPAP治疗HAPE的疗效和速度。方法：进行前瞻性、研究者发起、多中心、随机、双盲对照试验，比较高流量氧联合CPAP与假CPAP联合高流量氧（纯氧组）。结果：CPAP +高FiO2组与单独高流量氧组的HAPE分辨率相似。然而，这一发现应该谨慎地解释，因为这项研究的力量略显不足。两组分离时间差异无统计学意义（CPAP ~158 min vs氧气~178 min， p = 0.297）。两种治疗方法均有效，HAPE的平均缓解时间约为2.5至3小时。两组均未观察到与治疗相关的不良结果、插管或死亡率。结论：CPAP联合高流量氧和单独高流量氧治疗HAPE均有较好的疗效。CPAP在HAPE解决的时间上没有改善。高流量氧疗在HAPE治疗中需要的资源利用率显著降低，但效果相似。试验注册：ClinicalTrials.gov标识符：NCT04186598。
期刊介绍：
Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine.
The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more.
Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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