Role of CPAP/BiPAP in acute pulmonary edema due to heart failure?

• A. Not useful
• B. Only for chronic management
• C. CPAP improves oxygenation and reduces work of breathing; may reduce preload; used in select, cooperative patients
• D. Contraindicated

Answer: (C)

In acute pulmonary edema from heart failure, noninvasive positive pressure ventilation (CPAP or BiPAP) is valuable because it supports the lungs without intubation. The continuous or biphasic positive pressure keeps alveoli open, recruits collapsed airways, and improves gas exchange, which reduces the work of breathing and helps oxygenation quickly. The positive pressure also lowers the amount of blood returning to the heart (preload) by increasing intrathoracic pressure, which helps reduce pulmonary edema and left‑sided filling pressures. This approach buys time for other therapies, like diuretics and vasodilators, to take effect. It’s most effective in cooperative patients who can protect their airway and tolerate a mask, and it’s not used in those with contraindications such as altered mental status, inability to protect the airway, hemodynamic instability, facial trauma, or a high risk of aspiration.