A prospective observational study on bolus administration of high-dose nitroglycerin in treating sympathetic collapsing acute pulmonary oedema
DOI:
https://doi.org/10.18203/2320-6012.ijrms20233994Keywords:
High-dose nitroglycerin, Non-invasive ventilation, Sympathetic crashing, Acute pulmonary edemaAbstract
Background: Sympathetic crashing causes sudden cardiac failure in minutes or hours. Early diagnosis and treatment may avoid acute heart failure fatalities. Sympathetic crashing reduces afterload, shifting fluid into the pulmonary circulation and causing pulmonary edema. The usual strategy of progressively increasing vasodilator dosage has increased preload. Treating SCAPE with large doses of nitroglycerin and non-invasive breathing is helpful. High doses of nitroglycerin boost afterload and eliminate ICU admissions. In this study, a standard protocol for the treatment of patients with sympathetic crashing acute pulmonary edema is assessed for its effectiveness.
Methods: An observational study was conducted prospectively at Bhima Bhoi Medical College and Hospital in Balangir, Odisha, India over the course of a year. The patients presenting with SCAPE symptoms were treated according to standard protocol. The outcomes were subjected to statistical analysis to derive a correlation between treatment and response.
Results: The mean initial bolus given to all the patients was 836 µg. The total cumulative dose of nitroglycerin used in each patient was 36 mg. The symptoms of most of the patients resolved within the first 6 hours of treatment.
Conclusions: The standard protocol developed at the institute, which included a high dose of nitroglycerine along with non-invasive ventilation, was efficient in treating acute heart failure due to sympathetic crashing and acute pulmonary edema. Nitroglycerin, along with non-invasive ventilation, should be used in the management of sympathetic crashing pulmonary edema and acute heart failure.
References
Viau DM, Sala-Mercado JA, Spranger MD, O'Leary DS, Levy PD. The pathophysiology of hypertensive acute heart failure. Heart. 2015;101(23):1861-7.
Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med. 2016;20(12):719-23.
Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50(8):768-77.
Beltrame JF, Zeitz CJ, Unger SA, Brennan RJ, Hunt A, Moran JL, et al. Nitrate therapy is an alternative to furosemide/morphine therapy in the management of acute cardiogenic pulmonary edema. J Card Fail. 1998;4(4):271-9.
Wakai A, McCabe A, Kidney R, Brooks SC, Seupaul RA, Diercks DB, et al. Nitrates for acute heart failure syndromes. Cochrane Database Syst Rev. 2013;2013(8):CD005151.
Colucci WS, Elkayam U, Horton DP, Abraham WT, Bourge RC, Johnson AD, et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med. 2000;343(4):246-53.
Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-31.
Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144-52.
Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J. 2005;81(960):637-43.
Collins SP, Mielniczuk LM, Whittingham HA, Boseley ME, Schramm DR, Storrow AB. The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review. Ann Emerg Med. 2006;48(3):260-9.
