Treatment of the adult respiratory distress syndrome with continuous positive airway pressure.

Fifteen patients in the early stages of the adult respiratory distress syndrome with severe hypoxemia who were capable of maintaining adequate spontaneous ventilation were treated with continuous positive airway pressure (CPAP). The optimal level of CPAP was adjusted for each patient to achieve the highest oxygenation with the least adverse hemodynamic effects. The optimal intravascular volume, judged by pulmonary arterial occlusion pressure, was maintained by infusion of lactated Ringer's solution. Application of an optimal CPAP ranging between 10 and 25 cm H2O significantly reduced the intrapulmonary shunt, increased the forced vital capacity, and decreased the respiration rate. The improvement in pulmonary status was achieved with no significant changes in cardiac output or the arterial-mixed venous oxygen content difference. Early application of an adjusted level of positive end-expiratory pressure using CPAP in patients with adequate levels of fluid is an effective and safe method of treating selected groups of patients in the early stages of the adult respiratory distress syndrome.