Emergency Management of Acute Pulmonary Edema

Excerpt

Recent studies on acute pulmonary edema secondary to left ventricular failure (1, 2) have shed new light on the accompanying metabolic and ventilatory abnormalities and have reopened old questions and controversies concerning the appropriate management. Although the standard teaching in both cardiology and respiratory textbooks has been that patients with acute pulmonary edema (unless they are desperately ill) have respiratory alkalosis and no metabolic disturbances, the majority, in fact, may have lactic acidosis (3) and a large minority, perhaps as many as 30%, may have carbon dioxide retention (1, 2). The lactic acidosis is no doubt a reflection of perfusion