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Treatment of Respiratory Failure With Noninvasive Continuous Positive Airway Pressure
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To the Editor: Dr Delclaux and colleagues1 present data from 123 adult patients with acute respiratory failure who were randomized to receive either oxygen therapy alone or oxygen therapy plus continuous positive airway pressure (CPAP) applied by face mask. It appears that, in the subgroup of patients (n = 21) classified as having pure cardiac decompensation, CPAP neither reduced the need for intubation nor improved outcomes in hypoxemic nonhypercapnic respiratory insufficiency. These findings are surprising. Indeed, a number of randomized studies2-4 have reported that patients with cardiogenic pulmonary edema may benefit from CPAP delivered by face mask. However, because cardiac decompensation was poorly defined in this study (neither pulmonary artery wedge pressure, left ventricular systolic function, nor diastolic function were assessed), this group of patients may have represented a range of etiologies. Acute cardiac failure was considered likely if a history of preexisting cardiac disease or clinical signs of heart . . . [Full Text of this Article]
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