Nitroglycerin can be used at 5 to 10 mcg/min initially and can be increased gradually to the maximum recommended dose (200 mcg/min) while closely monitoring the hemodynamic responses. Nitrates (nitroglycerin and isosorbide dinitrate) cause greater venodilation than arterio-dilation and can be used intravenously in recommended doses. When they are needed, they should be used with great caution while monitoring hemodynamic response under expert opinion. Vasodilator therapy has to be used with great caution since it can cause symptomatic hypotension, and the evidence of its efficacy and safety is very limited. Diuretic therapy for patients who have not received diuretics previously is as follows:įor patients with refractory heart failure and decreased cardiac output A prospective observational study suggested that early treatment with furosemide in patients with AHF lowers the in-hospital mortality, and the mortality increased with delay in the time of administration. Patients with HF and features of pulmonary edema receiving treatment with early administration of diuretics had better outcomes according to guidelines of the American College of Cardiology Foundation/ American Heart Association Task Force. Patients presenting with acute decompensated heart failure (ADHF) with features of pulmonary edema should be treated with intravenous diuretics initially, regardless of the etiology. Sodium restriction is also necessary for patients with HF. VTE prophylaxis is generally indicated in patients admitted with acute heart failure. The aggressiveness of treatment depends upon the initial presentation, hemodynamic, and volume status of the patient. If the patient does not improve or have contraindications to NIV, then intubation and mechanical ventilation (with high positive end-expiratory pressure) should be considered.īIPAP can help move the fluid out of the lungs by increasing the intrapulmonary pressureĪfter initial resuscitation and management, the mainstay of treatment in acute settings is diuresis with or without vasodilatory therapy.
#Edem pulmonar trial#
If the respiratory distress and hypoxemia continue on oxygen supplementation, a trial of non-invasive ventilation should follow if there are no contraindications of NIV, as evidence suggests that it lowers the need for intubation and improves respiratory parameters. Nasal cannula and face mask -> Non-rebreather mask -> Trial of non-invasive ventilation (NIV) -> Intubation and mechanical ventilation Supplemental oxygen if necessary should be given in the following order: Unnecessary oxygen should not be administered as it causes vasoconstriction and reduction in cardiac output. Supplemental oxygen is a requirement if the patient is at risk of hypoxemia (SPO2 less than 90% ). After initial airway clearance, oxygenation assessment, and maintenance, management mainly depends upon presentation and should be tailored from patient to patient.
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