Intubation

A modest amount of favorable experimental evidence exists to support the use of CPAP in patients with cardiogenic pulmonary edema. CPAP appears to decrease intubation rates and data suggest a trend toward a decrease in mortality

http://www.chestjournal.org/cgi/reprint/114/4/1185

http://www.breas.com/breas_templates/Page____56.aspx

We've been using CPAP with our Pulmonary Edema patients for quite some time now...I have seen it work very well in helping patients get over that hump so we can medicinally turn them around without having to intubate...It works especially well in those with co-morbidities esp COPD, alot of patients which would never be weenable if they were to be tubed. The biggest hurdle is patient compliance, CPAP is not comfortable when you are breathing normal let alone having difficulty...they often feel as if they are smothering with the mask and force of air...We often need to give our patients a little something to take the edge off...usually some Morphine...both to decrease preload and their high anxiety level...

Sounds like ya'll do excellent work. :)

We've been using CPAP with our Pulmonary Edema patients for quite some time now...I have seen it work very well in helping patients get over that hump so we can medicinally turn them around without having to intubate...It works especially well in those with co-morbidities esp COPD, alot of patients which would never be weenable if they were to be tubed. The biggest hurdle is patient compliance, CPAP is not comfortable when you are breathing normal let alone having difficulty...they often feel as if they are smothering with the mask and force of air...We often need to give our patients a little something to take the edge off...usually some Morphine...both to decrease preload and their high anxiety level...

We use CPAP prehospitally and have had very good success with it. I would much rather CPAP a patient rather than RSI them and put them on a vent, the only exception being in an acute MI were some research shows that intubation is superior to CPAP for overall mortality. (If you really want I will try to find the references for that because I dont have them off hand)

The problem we have with CPAP and even BIPAP is that even though myself and many emergency nurses are trained in setting it up, our lovely resp. consultant in the hospital states we have to call the on-call physio to set it up, thus causing a delay of up to an hour ***frustrating***