Chest
Volume 107, Issue 5, May 1995, Pages 1379-1386
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Clinical Investigations in Critical Care
Reappraisal of Continuous Positive Airway Pressure Therapy in Acute Cardiogenic Pulmonary Edema: Short-term Results and Long-term Follow-up

https://doi.org/10.1378/chest.107.5.1379Get rights and content

To investigate whether serial incremental continuous positive airway pressure (CPAP) has any short-term or long-term advantages over face-mask oxygen therapy by way of intrapulmonary shunt reduction, 100 patients admitted to the coronary care unit for the treatment of acute cardiogenic pulmonary edema were studied. All patients received Swan-Ganz catheterization. Hemodynamic and pulmonary function parameters were recorded over the next 6 h, and the patients were followed until hospital discharge. All survivors received regular follow-up at 1-month intervals in the outpatient clinic. During the first-stage investigation period (3 h) PaO2 in the CPAP group showed a significant increase, whereas the intrapulmonary shunt and alveolar-arterial oxygen tension gradient (P[A-a]O2) was significantly reduced (p<0.005). The CPAP group had significantly lower rate-pressure product and higher stroke volume index compared with the control group. The therapeutic failure rate over 6 h was 24% in the CPAP group and 50% in the control group (p<0.01). The CPAP group had a significantly lower incidence of tracheal intubation and ventilator therapy than the control group; however, there was no significant difference in short-term mortality and hospital stay between the two groups. In conclusion, although study size was not large enough to demonstrate a difference in mortality, CPAP therapy resulted in physiologic cardiovascular and pulmonary function improvement and significantly reduced the need for intubation; however, it did not decrease mortality in patients with acute cardiogenic pulmonary edema, and a much larger study is needed to investigate this possibility.

Section snippets

Patient Selection

From January 1, 1986, to December 31, 1992, all patients who presented with acute cardiogenic pulmonary edema, admitted to the coronary care unit of the Veterans General Hospital-Kaohsiung and Taipei, were considered potential candidates for participation in this prospective study. All patients underwent Swan-Ganz catheterization. To ensure relatively uniform medical treatment at study entry, a consensus was achieved on management guidelines for cardiogenic pulmonary edema: (1) if systolic

Results

During the period from January 1, 1986, to December 31, 1992, 100 patients who suffered from acute cardiogenic pulmonary edema were randomly assigned either to receive oxygen alone (control, n=50) or to receive oxygen plus serial, incremental CPAP therapy (n=50). Among them, 85 patients were recruited from the Emergency Department and 15 patients were recruited during hospitalization. No significant differences were found between these two groups at study entry (Table 1). Upon initial

Discussion

This study confirms that CPAP delivered through a face mask has several advantages over supplemental oxygen alone in the management of acute cardiogenic pulmonary edema.1, 2, 3, 4, 5 CPAP resulted in significant improvement in respiratory rate and intrapulmonary shunt and oxygenation, and fewer patients who received CPAP therapy required tracheal intubation.1, 2, 3 Although the avoidance of tracheal intubation and ventilator therapy by CPAP technique has been described previously,1, 2, 3 this

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