A 68-year-old man presents with acute cardiogenic pulmonary oedema, respiratory rate 32/min, SpO2 86% on facemask, blood pressure 160/95 mmHg and normal sensorium. Which ventilatory support is most appropriate?
- A Continuous positive airway pressure at 8 to 10 cmH2O ✓
- B Bilevel positive airway pressure with IPAP 12 and EPAP 4 cmH2O
- C High-concentration oxygen by non-rebreathing mask alone
- D Immediate intubation and invasive mechanical ventilation
Correct answer: A. Continuous positive airway pressure at 8 to 10 cmH2O
Explanation
CPAP is first-line non-invasive support in acute cardiogenic pulmonary oedema with preserved consciousness. Positive intrathoracic pressure reduces venous return (preload) and LV transmural pressure (afterload), redistributing alveolar oedema fluid. Hypercapnic COPD exacerbations favour bilevel support, but this patient has pure pulmonary oedema without CO2 retention, making EPAP-only CPAP the better choice. Intubation is reserved for refractory hypoxaemia, exhaustion or depressed sensorium.
Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.