EXPERIENCE WITH THE USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)THERAPY IN THE EMERGENCY MANAGEMENT OF ACUTE SEVERE CARDIOGENIC PULMONARY-EDEMA

Background: Acute pulmonary oedema (APO) is a frequent cause of respir atory failure and a common reason for presentation to emergency depart ments (EDs). To date, no paper has been published on the application o f continuous positive airway pressure (CPAP)) therapy for a large broa d-based patient group. Aim: To report our experience with the use of C PAP in severe APO oedema, with particular reference to safety, intubat ion rates and impact on EDs' resources.Method: A retrospective chart r eview was undertaken of 75 patients with acute severe pulmonary oedema who were treated with adjuvant CPAP in an urban teaching hospital ED. Results: Three patients (4%) required subsequent endotracheal intubat ion and mechanical ventilation. The average duration of CPAP was 1.9 h ours. Eighty nine per cent of patients experienced no adverse events w hile being treated with CPAP. Five patients failed to tolerate the tig ht fitting mask necessitating removal of CPAP, three patients experien ced arrhythmias related to underlying cardiac disease and two patients experienced mild transient hypotension. Seventy one per cent of patie nts were discharged from the ED to general medical wards. The in-hospi tal mortality for patients treated with CPAP was 15%. Conclusion: This series has demonstrated that CPAP therapy delivered via a face mask f or the treatment of acute severe APO is safe and effective when applie d to a broad range of patients. We recommend the use of CPAP therapy f or all suitable patients presenting in severe APO irrespective of age or underlying pulmonary disease.