EVALUATION OF BILEVEL NONINVASIVE VENTILATION AGAINST CONVENTIONAL OXYGEN THERAPY IN THE TREATMENT OF ACUTE CARDIOGENIC PULMONARY EDEMA

Abstract

Background: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening emergency associated with acute respiratory failure and significant mortality. Non-invasive ventilation, particularly bilevel positive airway pressure (BiPAP), has emerged as an effective alternative to conventional oxygen therapy (COT) in improving oxygenation and reducing respiratory distress. This study aimed to compare the efficacy and safety of BiPAP with conventional oxygen therapy in the management of ACPE. Methodology: This prospective randomized comparative study included 100 patients diagnosed with ACPE admitted to the emergency department. Patients were randomly divided into two groups: Group I received BiPAP along with standard anti-failure treatment, while Group II received conventional face mask oxygen therapy with anti-failure measures. Clinical examination, arterial blood gas analysis, electrocardiography, echocardiography, APACHE II scoring, and laboratory investigations were performed in all patients. Statistical analysis was conducted using SPSS version 25.0, and p<0.05 was considered statistically significant. Result: Patients with decompensated heart failure, ischemic heart disease, valvular heart disease, elevated pulmonary artery systolic pressure, and reduced ejection fraction showed significantly higher use of BiPAP (p<0.05). Echocardiographic abnormalities including RWMA, severe mitral regurgitation, and advanced diastolic dysfunction were more common in the BiPAP group. APACHE II score >20 demonstrated high sensitivity and specificity in predicting BiPAP requirement. Conclusion: BiPAP is an effective and safe modality in patients with acute cardiogenic pulmonary edema, especially among those with severe cardiac dysfunction and respiratory compromise. Early initiation of BiPAP may improve clinical outcomes and reduce progression to invasive ventilation.