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Clinical InvestigationsContinuous Positive Airway Pressure and Supplemental Oxygen in the Treatment of Cardiogenic Pulmonary Edema
Section snippets
Patients
The study group consisted of 40 patients who had respiratory failure with clinical and roentgenographic evidence of acute alveolar pulmonary edema of cardiac origin. The diagnostic criteria for respiratory failure were as follow: difficulty in breathing spontaneously expressed by the patient; signs of increased respiratory work, such as intercostal and suprasternal retractions or use of accessory respiratory muscles during inspiration; respiratory rate of more than 25 breaths per minute; or
RESULTS
The two groups were found to be comparable with regard to age, gender, underlying cause of pulmonary edema, cardiothoracic ratio, medical treatment (Table 1), and baseline cardiopulmonary function (Table 2). The study was not interrupted in any patient. No complication could be attributed to the type of therapy or to the equipment used.
DISCUSSION
Several reports describe a favorable therapeutic response to CPAP in patients with acute cardiogenic respiratory failure.1, 2, 4 An increase in functional residual capacity improves both gas exchange and the mechanical function of the lung producing simultaneous improvement in arterial blood oxygenation and reduction in respiratory work.7 Relief of respiratory distress with CPAP has been shown to be associated with significant hemodynamic improvement, reversal of hypertension and tachycardia,
ACKNOWLEDGMENTS
The authors wish to thank the physicians and the nursing staff of the Emergency Department and the Intensive Care Unit of the Helsinki University Central Hospital for their cooperation during this study, John B. Downs, M.D., for reviewing the manuscript, and Mary L. Tigner for editing it for style.
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Manuscript received July 21 revision accepted January 22.