Optimum versus clinically established levels of continuous positive airway pressure in respiratory therapy

To evaluate the efficacy of our routine method of cardiopulmonary monitoring for accurate management of respiratory therapy, continuous positive airway pressure (CPAP) was titrated in 11 surgical intensive care patients within ±7.5 cm H₂O of the clinically selected level. Cardiopulmonary data were independently and retrospectively reviewed by three experienced critical care physicians from three outside hospitals. Each physician estimated the optimum level of CPAP for each patient. Variability between reviewers was not statistically significant. The optimum CPAP level based on all reviewers' opinions (8.6±5.7 cm H₂O, mean±SD) was significantly lower than that selected clinically (13.2±4.5 cm H₂O;P<0.05). We conclude that current methodology for monitoring respiratory therapy is inefficient for rapid adjustment of CPAP to appropriate levels. Continuous arterial and pulmonary artery oximetry may provide an improvement in the efficacy of cardiopulmonary monitoring in the future.