27003
document
The efficacy of early continuous positive airway pressure therapy in patients with acute cardiogenic pulmonary edema . Although continuous positive airway pressure ( CPAP ) therapy using a face mask is known to improve oxygenation , the intrapulmonary shunt reduction remains unsettled . Our study was designed to explore this issue . From 1985 to 1987 80 patients with acute cardiogenic pulmonary edema were randomly chosen to receive either serial CPAP therapy or high-flow face mask oxygen therapy without CPAP ( control ) for the purpose of evaluating the efficacy of CPAP therapy . After screening for exclusion , only 55 patients were included in the first 3-hour investigation period . PaO2 in the CPAP group showed a significant increase by the end of the initial study ; whereas intrapulmonary shunt and alveolar-arterial oxygen tension gradient AaDO2 revealed simultaneously a significant reduction . Conversely , neither PaO2 nor intrapulmonary shunt ( or AaDO2 ) in the control group demonstrated any significant beneficial changes . As for cardiovascular function , only the CPAP therapy achieved a significant reduction in rate pressure product in contrast to the control ( face mask ) therapy alone . In terms of therapeutic failure , 10 patients in the control group failed . However , in the CPAP group only 5 patients had failed at the end of the first 3-hour study period . Overall , the cumulative therapeutic failure rate was 28 % in the CPAP group and 60 % in the control group during a 6-hour observation study . However , there was no significant difference between the two groups in 24-hour hospital mortality . ( ABSTRACT TRUNCATED AT 250 WORDS )
27004
Intervention_Physical
serial CPAP therapy
27005
Intervention_Control
high-flow face mask oxygen therapy without CPAP ( control )
27006
Outcome_Physical
PaO2
27007
Outcome_Physical
intrapulmonary shunt
27008
Outcome_Other
alveolar-arterial oxygen tension gradient AaDO2
27009
Outcome_Physical
rate pressure product
27010
Outcome_Physical
therapeutic failure
27011
Outcome_Other
cumulative therapeutic failure rate
27012
Participant_Condition
acute cardiogenic pulmonary edema .
27013
Participant_Sample-size
80
27014
Participant_Condition
acute cardiogenic pulmonary edema
27015
Participant_Sample-size
55