Respiratory Acidosis as a Consequence of Pulmonary Edema

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Abstract
Pulmonary edema is commonly attended by arterial O2 desaturation together with hyperventilation as manifested by low arterial PCO2. This report deals with 4 patients seen over a 6 month period who had severe CO2 retention on the basis of pulmonary edema. Serial measurements of arterial pH, PCO2 and bicarbonate were made in all cases, and arterial lactate in 3. All patients showed little benefit from the usual treatment for pulmonary edema. Significant improvement was noted only when respiratory failure was recognized and corrected. Three cases required artificial ventilation with very high positive pressures. Intubation also allowed for the aspiration of foam, a major feature limiting gas exchange. All patients survived. It is likely that respiratory failure developed as a result of extensive airway obstruction and collapse with ventilatory volume reduced to critical levels. Respiratory failure may be common in near-terminal pulmonary edema, and in such instances the administration of morphine is probably contraindicated.