Document Detail

Rural treatment of acute cardiogenic pulmonary edema: applying the evidence to achieve success with failure.
MedLine Citation:
PMID:  18796257     Owner:  NLM     Status:  MEDLINE    
Rural management of acute cardiogenic pulmonary edema should be based on avoidance of adverse outcomes such as in-hospital mortality, the need for intensive care unit care, and the need for intubation and mechanical ventilation. Current evidence suggests that early noninvasive continuous positive airway pressure and early aggressive preload reduction with intravenous nitroglycerin are first-line interventions. Afterload reduction with sublingual captopril, with or without nitroglycerin, improves outcomes and is a second-line intervention. Furosemide is associated with adverse outcomes when used alone and should be given only after vasodilator therapy as a third-line intervention. Inotropes should be used only with demonstrably poor perfusion as they do not improve outcomes and may indeed be associated with increased mortality. Concurrent vasodilator therapy should be considered as soon as possible. Morphine should not be used as it is associated with adverse outcomes. If sedation is desirable, benzodiazepines should be considered.
John Bosomworth
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada     Volume:  13     ISSN:  1203-7796     ISO Abbreviation:  Can J Rural Med     Publication Date:  2008  
Date Detail:
Created Date:  2008-09-17     Completed Date:  2008-11-18     Revised Date:  2009-03-31    
Medline Journal Info:
Nlm Unique ID:  9708550     Medline TA:  Can J Rural Med     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  121-8     Citation Subset:  IM    
Department of Family Practice, University of British Columbia, Vancouver, BC.
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MeSH Terms
Acute Disease
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  economics,  therapeutic use
Benzodiazepines / therapeutic use
Captopril / administration & dosage,  economics,  therapeutic use
Continuous Positive Airway Pressure / methods*
Diagnosis, Differential
Diuretics / therapeutic use
Emergency Medicine / methods*
Furosemide / therapeutic use
Heart Failure / complications,  therapy*
Nitroglycerin / administration & dosage,  therapeutic use
Pulmonary Edema / etiology,  therapy*
Treatment Outcome
Vasodilator Agents / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Vasodilator Agents; 12794-10-4/Benzodiazepines; 54-31-9/Furosemide; 55-63-0/Nitroglycerin; 62571-86-2/Captopril
Comment In:
Can J Rural Med. 2009 Winter;14(1):29; author reply 29-30   [PMID:  19146792 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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