Management of acute cardiogenic pulmonary edema: a literature review.
Acute cardiogenic pulmonary edema (CPE) is a pathology frequently seen in patients presenting to emergency departments (EDs) and can usually be attributed to preexisting cardiovascular disease. Heart failure alone accounts for more than 1 million hospital admissions annually and has one of the highest ED morbidity and mortality to date (). Historically, CPE has been managed by the treating clinician in a manner that is based largely on anecdotal evidence. Furosemide (Lasix), morphine, and nitroglycerin have historically been the baseline standard for drug therapy in CPE management. A lack of drastic improvement in the patient's condition over the course of the ED visit may reflect a management style that results in higher morbidity and mortality for CPE patients. Several recent articles provide evidence-based outcomes that suggest changing standard therapy along with the adjunctive use of other medications. These articles also describe treatment modalities that result in a marked improvement in the management of patients with CPE along with decreases in adverse outcomes and hospital length of stay. The goal of this article is to present a summary of the evidence regarding the management of CPE and discuss the implications for current practice.
Johnson
Jeremy M
JM
Adult Emergency Department, University of Mississippi Medical Center, Jackson, MS 39216, USA. jmjohnson2@nursing.umsmed.edu
D000208:Acute Disease; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004489:Edema, Cardiac / Q000453:epidemiology / Q000503:physiopathology; D005665:Furosemide / Q000627:therapeutic use*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D009419:Nerve Tissue Proteins / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000627:therapeutic use*; D010100:Oxygen / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000627:therapeutic use*; D011654:Pulmonary Edema / Q000453:epidemiology / Q000503:physiopathology; D014665:Vasodilator Agents / Q000627:therapeutic use*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001993:Bronchodilator Agents; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D014665:Vasodilator Agents; C095026:brain natriuretic peptide-35, rat; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005665:Furosemide; D005996:Nitroglycerin; D010100:Oxygen