title: Implementation of Boussignac continuous positive airway pressure in the coronary care unit: experiences and attitudes.
abstract: 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.
  
  
  CONCLUSIONS
  Overestimation of patient discomfort by nurses and system-related factors impeded the use of BCPAP for all patients with ACPE.
authors.affiliation: Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Dieperink
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Mark
authors.initials: M
authors.lastname: van de Stadt
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Leon P H J
authors.initials: LP
authors.lastname: Aarts
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods*; D003325:Coronary Care Units; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000451:nursing; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000451:nursing / Q000628:therapy*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016896:Treatment Outcome