RESULTS

• pH = 7.21
• paC02 = 54 mmHg
• pa02 = 81 mmHg
• Sa02 = .69

EVALUATION

Pump failure induced acute pulmonary edema with severe masked hypoxemia and early respiratory failure.

INITIAL CLINICAL GOAL

To improve oxygenation and respiratory function. (restoration of functional residual capacity {FRC} improve alveolar filling and improve pulmonary compliance.)

INITIAL TREATMENT

1. Begin CPAP via facemask at +5 cmH20 at an FIO2 of 40%. A very modest reduction in work of breathing noted.
2. CPAP increased to 10 cmH20.

The respiratory frequency dropped to 32/minute; S02 – increased to 88%; BP – 144/88 and the skin color has gone from cyanosis to pale with no cyanosis. The skin has become less diaphoretic and his work of breathing improved.

REPEAT ABG

• pH = 7.40
• PaCO2 = 31 mmHg
• Pa02 = 188 mmHg
• Sa02 = .92
• FI02 - .40

DISCUSSION

Patients presenting with cardiogenic acute pulmonary edema (congestive heart failure) are experiencing several acute derangements of their pulmonary function caused by fluid being forced through the alveolar capillary membrane and into the interstitial spaces. The lungs lose compliance, the FRC reduced and there is a substantial reduction of alveolar capillary membrane required for adequate gas exchange. The reduction of the alveolar volume is worsened during expiration. Some patients experience respiratory acidosis due to the inability to maintain adequate minute volume due to the shift of the compliance curve. By addressing these issues using carefully titrated end-expiratory pressure, a significant amount of overall stabilization takes place. The substantive therapy often includes reopening coronary arterial circulation; and inotropic support.