A PROSPECTIVE-STUDY OF SPONTANEOUS VENTILATION IN POSITIVE EXPIRATORYPRESSURE IN CARDIOGENIC PULMONARY-EDEMA

New equipment facilitating the use of spontaneous ventilation with pos itive expiratory pressure (PEP) has become available in France since J anuary 1996. This technique was applied in 38 patients with severe car diogenic pulmonary oedema and persistent respiratory distress despite high flow classical oxygen therapy and standard treatment. After 1 hou r of Ventilation with a flow of 220 l/min of 100% oxygen with an avera ge PEP of 7.1 cm H2O, a significant improvement of clinical (heart and respiratory rate) and biological parameters (arterial gases) was obse rved. There were no side effects. Four patients died during the hospit al period and only 1 was intubated. Spontaneous ventilation with PEP i s a simple technique for coronary care units and, compared with conven tional oxygen therapy, it rapidly improves arterial oxygenation, reduc es respiratory work and improves conditions of cardiac load. Acute sev ere cardiogenic pulmonary oedema seems to be an indication of choice, especially in the elderly where it may help avoid an often controversi al intubation.