A patient with congestive heart failure has severe hypoxemia and dyspnea while using a non-rebreather mask. Which of the following interventions would be appropriate for the therapist to institute at this time? I. pressure support ventilation with PEEP II. mask CPAP III. nebulized morphine IV. PRVC

A. III only?B. I, II only
C. I, IV only
D. I, II, IV only

ANS: B (page 368)
Cognitive Level: Application
A. Incorrect response: See explanation B.
B. Correct response: Positive-pressure is known to increased the FRC, improve lung compliance, and oxygenation. The increased intrathoracic pressure reduces preload and afterload, enhancing cardiac function in patients with pulmonary edema caused by left ventricular dysfunction.
Clinical research has demonstrated that NPPV in the form of CPAP dramatically improved dyspnea and oxygenation, and lowered intubation rates in patients with acute pulmonary edema compared with standard O2 therapy. Studies evaluating the efficacy of NPPV (i.e., pressure support ventilation and PEEP) compared with either O2 therapy or CPAP alone have shown benefits similar to those revealed by CPAP.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.