Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema

Abstract

The therapeutic efficacy of continuous positive airway pressure (CPAP) administered by face mask was studied in 40 patients with acute cardiogenic pulmonary edema and respiratory failure. Arterial blood gas values and pH, systemic arterial pressure, heart rate and respiratory rate were measured during administration of 30% oxygen with a high-flow face mask apparatus at ambient airway pressure. Twenty patients were then randomly chosen to continue ambient airway pressure breathing and 20 received 10 cm H 2O of CPAP. The measurements were repeated 10, 60 and 180 minutes after therapy was initiated. During the first 10 minutes of CPAP treatment, arterial blood oxygen partial pressure increased 8 ± 9 mm Hg (mean ± 1 standard deviation), (p < 0.01) and respiratory rate decreased 5 ± 5 breaths/min (p < 0.001). Systolic arterial pressure decreased 12 ± 21 mm Hg (p < 0.05), and heart rate by 10 ± 11 beats/min (p < 0.001). A decrease in respiratory rate by 2 ± 5 breaths/min (p < 0.05) was the only change that occurred in the control group. The improvement in arterial blood oxygenation persisted throughout the investigation period (p < 0.05). Thirteen patients (65%) in the control group and 7 patients (35%) in the CPAP group met our criteria for treatment failure during the study (p = 0.068). Thus, CPAP administered by face mask improves gas exchange, decreases respiratory work, unloads circulatory stress, and may reduce the need for ventilator treatment in acute cardiogenic pulmonary edema.