Continuous positive airway pressure (CPAP) would be contraindicated in which scenario?

• A. Pulmonary edema, history of hypertension, and anxiety
• B. Difficulty breathing, two-word dyspnea, and tachycardia
• C. Conscious and alert patient with an oxygen saturation of 85%
• D. Shortness of breath and a blood pressure of 76/56 mm Hg

Answer: (D)

The key idea is that CPAP can worsen blood pressure when a patient is hemodynamically unstable. Positive airway pressure increases intrathoracic pressure, which reduces venous return to the heart and can lower cardiac output. In someone with severe hypotension (for example, a systolic around 76 mm Hg), applying CPAP can drop perfusion further and may be dangerous, so it is a contraindication.

The other scenarios don’t pose an absolute contraindication to CPAP. CPAP is commonly used for cardiogenic pulmonary edema and can assist oxygenation in hypoxemic patients who are awake and able to protect their airway. Anxiety or tachycardia alone aren’t definitive barriers, and an oxygen saturation of 85% in a conscious patient is a situation where CPAP could be considered with close monitoring, not categorically ruled out.