Question: We had a patient who presented with bi lateral crackles and patient was in obvious distress and fit all of CPAP criteria, however the patient had a temp of 38.5. I remember that during our training it was clearly demonstrated that a patient with pneumonia is contraindicated for use of CPAP. Upon looking over the protocols it is not mentioned as a contra indication. Would CPAP be an appropriate treatment? If so would it still be appropriate if this patient was suspected of having pneumonia a few days prior by nursing staff. Thank you.
Thanks for the terrific question. The issue at hand it to understand the most likely cause of the patient's respiratory distress. The indications for CPAP include severe respiratory distress AND signs and/or symptoms of acute pulmonary edema OR COPD. In the case you are describing, based upon the crackles (consistent with pulmonary edema or pneumonia but not classic for COPD) and the fever (consistent with pneumonia but not pulmonary edema), the most likely etiology is that of pneumonia as the cause of the respiratory distress. This is further reinforced by the nursing staff in your example suspecting pneumonia as well as the underlying cause. Therefore, to answer your question, although pneumonia is not listed as a contraindication, the fact that the indications are not met (not COPD or pulmonary edema), CPAP should not be utilized in the scenario you describe.