Continuous and bilevel positive airway pressure in the treatment of acute cardiogenic pulmonary edema

Patients with acute cardiogenic pulmonary edema (ACPE) are commonly seen in the emergency department (ED), Although the majority of patients respond t o conventional medical therapy, some patients require at least temporary ve ntilatory support. Traditionally, this has been accomplished via endotrache al intubation and mechanical ventilation, an approach that is associated wi th a small but significant rate of complications. The past 2 decades have w itnessed increasing interest in methods of noninvasive ventilatory support (NVS), notably continuous positive airway pressure (CPAP) and bilevel posit ive airway pressure (BiPAP), We review the physiological consequences, clin ical efficacy, and practical limitations of CPAP and BiPAP in the managemen t of ACPE. Copyright (C) 2000 by W.B. Saunders Company.