Material and Methods
We reviewed all 322 episodes of respiratory failure requiring treatment with mechanical ventilation in the Rochester (NY) General Hospital Medical Intensive Care Unit during 1985. Eighty-eight of these episodes in 79 individuals were caused by cardiogenic pulmonary edema.
Respiratory failure was attributed to cardiogenic pulmonary edema by clinical criteria. For inclusion, all episodes required at least two of the following in addition to pulmonary edema on roentgenogram: rales, elevated jugular venous pressure, peripheral edema, S-3 gallop, dyspnea with exertion, acute myocardial infarction, or acute ischemic chest pain. For each episode, both the attending physician and cardiologist agreed on the diagnosis of cardiogenic pulmonary edema. Chest roentgenograms were reviewed by the authors and each episode had diffuse alveolar or interstitial edema. No patient had risk factors predisposing to noncardiogenic pulmonary edema, such as sepsis, aspiration, and drug overdose, and no patient had purulent sputum or an inhospital clinical course suggesting pulmonary infection. Although not a criterion for inclusion, 32 patients had pulmonary artery balloon flotation catheters inserted.