N-CPAP in the prevention of recurrent intubations and hospitalizations in a patient with refractory congestive heart failure.

A 61-year-old woman with ischemic cardiomyopathy continued to have recurrent episodes of respiratory failure secondary to acute pulmonary edema requiring ventilatory support on each occasion, despite undergoing surgical revascularization and mitral valve replacement. These episodes of acute respiratory failure were successfully averted by using nocturnal nasal continuous positive airway pressure (N-CPAP). Following N-CPAP, she was able to stay home for 207 consecutive days. Although well-designed, controlled studies are needed to validate this observation, nocturnal N-CPAP is a viable and cost effective option that may be considered in a select number of patients with end-stage cardiopulmonary disease.