Pulmonary edema medical therapy

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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Medical Therapy

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

Cardiogenic pulmonary edema:

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

Oxygen therapy

• Administer oxygen as early as possible
• Achieve 95% arterial oxygen saturation (90% in COPD patients)
• Caution should be taken in patients with severe airway obstruction to avoid hypercapnia 

 Drug therapy 

• loop diuretics 
  • Recommended in the case of congestion and volume overload as the underlying cause of pulmonary edema
  • The recommended initial dose is bolus furosemide 20 – 40 mg i.v. (0.5 – 1 mg bumetanide; 10 -20 mg torasemide) on hospital admission
  • Total dose of furosemide is100 mg in the first 6 hours and 240 mg for the first 24 hours
  • Thiazides combined with loop diuretics can be useful in cases resistant to diuretics
  • In cases of acute cardiogenic pulmonary edema with volume overload, thiazides (hydrochlorothiazide 25 mg p.o.) and aldosterone antagonists (spironolactone, eplerenone 25-50 mg p.o.) can be used in combination with loop diuretics.
  • A combination of drugs in low doses is more effective and has less side effects than the use of higher doses of a single drug
  • Side Effects of Loop diuretics include:
    • Hypokalemia
    • Hyponatremia
    • Hyperuricemia
    • Hypovolemia
    • Dehydration
      • Urine output should be evaluate as frequent as possible
• Morphine and Its Analogues
  • May be given in the early stage of the treatment in patient with severe acute heart failure, especially if they present with restlessness, dyspnea, anxiety, or chest pain
  • Relieves dyspnea and other symptoms
  • Bolus of morphine 2.5 – 5 mg may be administered
  • Respiration should be monitored
  • Nausea often occurs and antiemetics therapy may be necessary
  • Extra caution when giving morphine in following conditions:
    • Hypotension
    • Bradycardia
    • Advanced AV block
    • CO2 retention
• Vasopressin Antagonists
• Vasodilators
• Inotropic agents
• Dobutamine
• Dopamin
• Vasopressor
• Milrinone and Enoximone
• Cardiac Glycosides