Implementation of Boussignac continuous positive airway pressure in the coronary care unit: Experiences and attitudes Willem Dieperink, RN, MSc, a,b Maarten W. N. Nijsten, MD, PhD, b Mark van de Stadt, RN, a Iwan C. C. van der Horst, MD, PhD, a Leon P. H. J. Aarts, MD, PhD, c Felix Zijlstra, MD, PhD, a and Tiny Jaarsma, RN, PhD a OBJECTIVE: Boussignac continuous positive airway pressure (BCPAP) delivered by face mask is useful for patients with acute cardiogenic pulmonary edema (ACPE). Although BCPAP is medically effective, we observed that not all suitable patients received it. In this descriptive, prospective, cohort study, we explored the experiences and attitudes of both patients and staff with BCPAP. METHODS: Patients were interviewed 12 to 48 hours after treatment with BCPAP. Nurses on the coronary care unit were interviewed on their knowledge, skills, experiences, and opinions concerning BCPAP. RESULTS: Of 117 patients with ACPE, 87 patients (74%) received BCPAP treatment. It was decided not to administer BCPAP in 30 patients with ACPE (26%). Patients who received BCPAP found that the reduction of dyspnea outweighed any discomfort. Barriers for the use of BCPAP were not related to nurses’ skills but to the following: the nurses’ belief that BCPAP created major discomfort, the lack of guidelines, the ultimate improvement of oxygenation without BCPAP, and the more labor-intensive treatment. CONCLUSION: Overestimation of patient discomfort by nurses and system-related factors impeded the use of BCPAP for all patients with ACPE. (Heart Lung® 2008;37:449 – 454.) A cute cardiogenic pulmonary edema (ACPE) caused by chronic heart failure is a common medical emergency that frequently manifests itself with sudden dyspnea and hypoxemia. When treatment with oxygen, opiates, diuretics, and vaso- dilators do not result in sufficient improvement, additional ventilatory support may be required. 1,2 Traditionally, ventilatory support has been effected via endotracheal intubation and mechanical venti- lation, an approach that usually requires admission to the intensive care unit. Several randomized clin- ical trials demonstrated a decrease in the rate of intubation and hospital length of stay for patients assigned to continuous positive airway pressure (CPAP) compared with conventional therapy with oxygen alone. 3-6 International heart failure guide- lines mention that CPAP treatment is an effective and accepted treatment option in these patients. 7,8 Coronary care units (CCUs) in The Netherlands are usually not equipped for applying respiratory sup- port with mechanical ventilators. Most nurses in the CCU are not trained to ventilate patients and have limited expertise and experience in the field of con- ventional mask CPAP. Therefore, we introduced the Boussignac continuous positive airway pressure (BCPAP) system (Fig 1) in the CCU. The BCPAP system is a simple disposable cylindric plastic de- vice that requires only an O 2 source and a flow meter to generate face mask CPAP. This easy-to- handle system can be used outside of the intensive From the a Thoraxcenter, Department of Cardiology, b Surgical Intensive Care Unit, and c Department of Anaesthesiology, Uni- versity Medical Center Groningen, University of Groningen, The Netherlands. Corresponding author: Willem Dieperink, RN, MSc, Surgical In- tensive Care Unit, University Medical Center Groningen, Univer- sity of Groningen, PO Box 30.001, 9700 RB Groningen, The Neth- erlands. 0147-9563/$ – see front matter Copyright © 2008 by Mosby, Inc. doi:10.1016/j.hrtlng.2007.12.006 ISSUES IN PULMONARY NURSING HEART & LUNG VOL. 37, NO. 6 www.heartandlung.org 449