Preoperative intermittent positive pressure respiration as preparation for emergency valvular surgery for pulmonary edema.

Immediate emergency surgery is the accepted treatment of intractable pulmonary edema due to valvular heart disease. The presence of severe tissue hypoxia, acidosis, low cardiac output state and renal insufficiency results in a high operative risk. Delay of operation by several hours may prove advantageous in that it permits improvements of the patient's condition by means of intermittent positive pressure respiration with correction of acidosis and at the same time allows for treatment of the cardiac failure. Three illustrative cases are presented, all successfully managed by preoperative treatment in an intensive care unit. The pathophysiological basis of this therapeutic approach is discussed.