Which ventilation strategy is recommended for noninvasive support in CHF/pulmonary edema?

• A. BiPAP
• B. Oxygen only
• C. CPAP or PEEP for MV
• D. Nasal cannula

Answer: (C)

In CHF with pulmonary edema, keeping the airways open and reducing the pressure that backs up into the lungs helps both oxygenation and breathing effort. Providing continuous positive airway pressure with CPAP delivers a steady level of positive pressure throughout the breath, which recruits collapsed alveoli, improves gas exchange, and lowers the work of breathing. That same positive-pressure effect is what PEEP achieves on a ventilator, so using CPAP or PEEP noninvasively gives the lung recruits and hemodynamic benefits without intubation. Oxygen by itself or a low-flow nasal cannula doesn’t provide this positive pressure to open collapsed areas, and while BiPAP can help, the decisive mechanism in edema management is the continuous positive pressure provided by CPAP (or the equivalent PEEP effect), making it the preferred noninvasive strategy.