Document Detail

Review article: lack of effect of opiates in the treatment of acute cardiogenic pulmonary oedema.
MedLine Citation:
PMID:  18973635     Owner:  NLM     Status:  MEDLINE    
Opiates have traditionally been used as one of the main treatments of acute heart failure and are still recognized as such. Most current textbooks and official guidelines advise the use of morphine as one of the first-line treatments for patients in acute cardiogenic pulmonary oedema and a majority of physicians accept it to be the case. The author performed an extensive literature search in order to validate the evidence for the use of opiates in this condition. A total of seven papers, six in English and one in Polish, were found that directly investigated or reported the clinically important outcomes of treatment of acute pulmonary oedema. Only five of these dealt specifically with the effects of administration of opiates in acute cardiogenic pulmonary oedema. None of the above publications suggested a clinically significant improvement in outcomes of patients treated with morphine, although early research did suggest reduced anxiety, blood pressure and pulse rate as well as a reduction in arterial oxygen contents. The more recent studies suggest a strong association between increased mortality and morbidity (e.g. intensive care unit admissions or intubation rates), although causality is difficult to establish because of research methodologies. The current evidence does not support the routine use of opiates in the treatment of acute pulmonary oedema.
Marcin A Sosnowski
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Emergency medicine Australasia : EMA     Volume:  20     ISSN:  1742-6723     ISO Abbreviation:  Emerg Med Australas     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-31     Completed Date:  2009-03-11     Revised Date:  2009-05-08    
Medline Journal Info:
Nlm Unique ID:  101199824     Medline TA:  Emerg Med Australas     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  384-90     Citation Subset:  IM    
Emergency Department, Wangani Hospital, Wanganui, New Zealand.
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MeSH Terms
Acute Disease
Anti-Anxiety Agents / therapeutic use
Evidence-Based Medicine
Heart Diseases / complications
Heart Failure / complications
Morphine / pharmacology,  therapeutic use*
Narcotics / pharmacology,  therapeutic use*
Pulmonary Edema / drug therapy*,  etiology,  physiopathology
Risk Factors
Vasodilation / drug effects
Reg. No./Substance:
0/Anti-Anxiety Agents; 0/Narcotics; 57-27-2/Morphine
Comment In:
Emerg Med Australas. 2009 Apr;21(2):160   [PMID:  19422415 ]
Emerg Med Australas. 2008 Oct;20(5):379-81   [PMID:  18973633 ]

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