Pulmonary edema medical therapy: Difference between revisions

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*** The Initial infusion rate is 0.3 ug/kg/minute with titration up to 5 ug/kg/minute  
*** The Initial infusion rate is 0.3 ug/kg/minute with titration up to 5 ug/kg/minute  


* Vasodilators lower systolic blood pressure, reduce left and right-heart filling pressure and systemic vascular resistance, as well as relieving dyspnea  
* Vasodilators effects include:
* Use vasodilators in acute cardiogenic pulmonary edema when
** lowering systolic blood pressure  
** Reducing left and right-heart filling pressure  
** Reducing systemic vascular resistance  
** Relieving dyspnea  
 
* Use vasodilators in acute cardiogenic pulmonary edema when:
** SBP > 110 mmHg  
** SBP > 110 mmHg  
* Side Effects of Vasodilators include:
* Side Effects of Vasodilators include:
Line 69: Line 74:
** Tachyphylaxis
** Tachyphylaxis
** Hypotension
** Hypotension
*** Titrating nitroglycerin i.v. gradually and monitoring blood pressure regularly to prevent drastic  systolic blood pressure decrease
*** Titrating nitroglycerin i.v. gradually and monitoring blood pressure regularly to prevent sudden decrease in systolic blood pressure
* '''Inotropic agents'''
* '''Inotropic agents'''
* '''Dobutamine'''
* '''Dobutamine'''

Revision as of 14:03, 7 March 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Pulmonary edema Microchapters

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Overview

Medical Therapy

Pulmonary edema classified into cardiogenic and non-cardiogenic pulmonary edema, each requires different management and has a different prognosis.[1]

Cardiogenic pulmonary edema:

The main goal of management is to alleviate symptoms and stabilize patient as well as to improve outcome.[2]

Oxygen therapy

 Drug therapy 

  • Two most studied vasopressin antagonists are:
  • Vasodilators
  • Vasodilators are recommended at initial phase of acute cardiogenic pulmonary edema
    • Intravenous nitrate
      • The initial recommended dose is 10 – 20 ug/minutes, which can be increased to 5 – 10 ug/minute every 3 – 5 minutes if required
    • Sodium nitroprusside
      • The Initial infusion rate is 0.3 ug/kg/minute with titration up to 5 ug/kg/minute
  • Vasodilators effects include:
    • lowering systolic blood pressure
    • Reducing left and right-heart filling pressure
    • Reducing systemic vascular resistance
    • Relieving dyspnea
  • Use vasodilators in acute cardiogenic pulmonary edema when:
    • SBP > 110 mmHg
  • Side Effects of Vasodilators include:
    • Headache
    • Tachyphylaxis
    • Hypotension
      • Titrating nitroglycerin i.v. gradually and monitoring blood pressure regularly to prevent sudden decrease in systolic blood pressure
  • Inotropic agents
  • Dobutamine
  • Dopamin
  • Vasopressor
  • Milrinone and Enoximone
  • Cardiac Glycosides

References

  1. Murray JF (February 2011). "Pulmonary edema: pathophysiology and diagnosis". Int. J. Tuberc. Lung Dis. 15 (2): 155–60, i. PMID 21219673.
  2. Alwi I (July 2010). "Diagnosis and management of cardiogenic pulmonary edema". Acta Med Indones. 42 (3): 176–84. PMID 20973297.
  3. 3.0 3.1 Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL (April 2008). "Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis". Emerg Med J. 25 (4): 205–9. doi:10.1136/emj.2007.050419. PMID 18356349.
  4. Konstam MA, Gheorghiade M, Burnett JC, Grinfeld L, Maggioni AP, Swedberg K, Udelson JE, Zannad F, Cook T, Ouyang J, Zimmer C, Orlandi C (March 2007). "Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial". JAMA. 297 (12): 1319–31. doi:10.1001/jama.297.12.1319. PMID 17384437.