Materiały źródłowe

• #1 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #2 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #3 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #4 Pulmonary Edema: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24218-pulmonary-edema

  Pulmonary edema is a serious condition. If you have sudden (acute) pulmonary edema, you need immediate treatment. You may need to be treated in the emergency room (ER) or intensive care unit (ICU). […] Some treatment options include: Oxygen delivered through prongs in your nose. Machines that blow air into your lungs through a mask on your face. Ventilators or respirators that blow in air through a tube inserted into your windpipe. Medications that cause you to urinate more and get rid of fluid or which strengthen your heart. Other medications, when congestive heart failure isn’t the cause of your pulmonary edema, such as antibiotics and steroids. […] If you have acute (sudden) pulmonary edema, you need immediate treatment. You may be treated in the emergency room (ER) or intensive care unit (ICU). Chronic pulmonary edema may require hospitalization as well.

• #5 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. […] Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications. […] Immediate treatment is necessary for acute pulmonary edema to prevent death. […] To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 meters) a day once you reach 8,200 feet (about 2,500 meters). […] Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

• #6 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #7 Pulmonary Edema: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/pulmonary-edema

  Pulmonary edema is a serious condition that requires quick treatment. Treatment for pulmonary edema may include: […] Oxygen may be the first line of treatment for this condition, depending on the severity. A healthcare team may prop you up and deliver 100 percent oxygen through an oxygen mask, nasal cannula, or positive pressure mask. […] In less severe cases, it may be treated with diuretics, or water pills. You may not have to stay in the hospital. This may be the case if you have congestive heart failure. […] A doctor will also diagnose the cause of pulmonary edema and prescribe the appropriate treatment for the underlying cause. […] Depending on your condition and the cause of your pulmonary edema, the doctor may also prescribe: […] In severe cases, people with pulmonary edema may need intensive or critical care.

• #8 Pulmonary edema (Fluid in the lungs): Causes, symptoms, and more

  https://www.medicalnewstoday.com/articles/167533

  Treatment of pulmonary edema usually focuses on improving respiratory function and addressing the source of the problem. It generally includes providing additional oxygen and medications to treat the underlying conditions. […] To raise a persons blood oxygen levels, a healthcare professional will administer oxygen through either a face mask or nasal cannulas, which are tiny plastic tubes that a healthcare professional places in a persons nose to provide oxygen. […] Healthcare professionals may place a breathing tube in the trachea if a ventilator a machine that helps a person breathe is necessary. […] If tests show that pulmonary edema is the result of a problem in the circulatory system, healthcare professionals will administer IV medications to help reduce fluid volume and regulate blood pressure.

• #9 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #10 Pulmonary edema: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000140.htm

  Pulmonary edema is almost always treated in the emergency room or hospital. You may need to be in an intensive care unit (ICU). […] Oxygen is given through a face mask or tiny plastic tubes are placed in the nose. […] A breathing tube may be placed into the windpipe (trachea) so you can be connected to a breathing machine (ventilator) if you cannot breathe well on your own (only needed in severe cases). […] The cause of pulmonary edema should be identified and treated quickly. For example, if a heart attack has caused the condition, it must be treated right away. […] Medicines that may be used include: […] Diuretics that remove excess fluid from the body […] Medicines that strengthen the heart muscle, control the heartbeat, or relieve pressure on the heart […] Other medicines when heart failure is not the cause of the pulmonary edema.

• #11 Pulmonary edema (Fluid in the lungs): Causes, symptoms, and more

  https://www.medicalnewstoday.com/articles/167533

  Treatment of pulmonary edema usually focuses on improving respiratory function and addressing the source of the problem. It generally includes providing additional oxygen and medications to treat the underlying conditions. […] To raise a persons blood oxygen levels, a healthcare professional will administer oxygen through either a face mask or nasal cannulas, which are tiny plastic tubes that a healthcare professional places in a persons nose to provide oxygen. […] Healthcare professionals may place a breathing tube in the trachea if a ventilator a machine that helps a person breathe is necessary. […] If tests show that pulmonary edema is the result of a problem in the circulatory system, healthcare professionals will administer IV medications to help reduce fluid volume and regulate blood pressure.

• #12 Pulmonary Edema > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pulmonary-edema

  Treatment includes supplemental oxygen, medications, mechanical ventilation, renal replacement therapy […] Common treatments for pulmonary edema include: Supplemental oxygen, may be delivered via a nasal cannula; Medications, including diuretics (to rid the body of excess fluid); nitroglycerin (to help lower pressure within the heart); inotropes (to help the heart pump more efficiently); and/or ACE inhibitors (to manage blood pressure levels); Morphine, which can help reduce anxiety and improve breathing; Continuous Positive Airway Pressure (CPAP), another method to improve breathing; Ventilators, which require intubation, may improve breathing when other methods are unsuccessful; Renal replacement therapy, when pulmonary edema causes kidney failure. […] Fortunately, pulmonary edema is a reversible condition, and the faster it is treated, the better the outcome is likely to be, says Yale Medicine pulmonologist Isabel Bazan, MD.

• #13 Pulmonary Edema > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pulmonary-edema

  Treatment includes supplemental oxygen, medications, mechanical ventilation, renal replacement therapy […] Common treatments for pulmonary edema include: Supplemental oxygen, may be delivered via a nasal cannula; Medications, including diuretics (to rid the body of excess fluid); nitroglycerin (to help lower pressure within the heart); inotropes (to help the heart pump more efficiently); and/or ACE inhibitors (to manage blood pressure levels); Morphine, which can help reduce anxiety and improve breathing; Continuous Positive Airway Pressure (CPAP), another method to improve breathing; Ventilators, which require intubation, may improve breathing when other methods are unsuccessful; Renal replacement therapy, when pulmonary edema causes kidney failure. […] Fortunately, pulmonary edema is a reversible condition, and the faster it is treated, the better the outcome is likely to be, says Yale Medicine pulmonologist Isabel Bazan, MD.

• #14 Pulmonary Edema: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/pulmonary-edema

  A machine will deliver oxygen under pressure to help get more air into your lungs. Sometimes this can be done with a mask or cannula, also called continuous positive airway pressure (CPAP). […] Your doctor may need to insert an endotracheal tube, or breathing tube, down your throat and use mechanical ventilation. […] Pulmonary edema requires prompt medical treatment.

• #15 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  The drugs used in treatment include nitrates, diuretics, morphine and inotropes. Some patients will require ventilatory support. […] Despite the widespread use of nitrates in acute pulmonary oedema, there is a lack of high-quality evidence to support this practice. […] There is a lack of controlled studies showing that diuretics are of benefit in acute pulmonary oedema. However, diuretics are indicated for patients with evidence of fluid overload. […] Morphine is therefore no longer recommended for routine use in acute pulmonary oedema. […] If required, oxygen should be administered to achieve a target oxygen saturation of 92-96%. […] Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema.

• #16 Can Pulmonary edema Be Treated? – Germanten Hospital

  https://www.germantenhospitals.com/can-pulmonary-edema-be-treated/

  Pulmonary oedema is a medical condition that is treatable. It occurs when there is an excess buildup of fluid in the air sacs of the lungs. […] The treatment for pulmonary oedema is available and it depends on the underlying cause and the severity of the condition. The following are some common treatment options: […] Medications: Diuretics are commonly used to help remove excess fluid from the lungs and improve breathing. Inotropes are used to help improve heart function. Morphine may be given to reduce anxiety and improve breathing, and blood pressure drugs can be used to reduce the workload on the heart. […] Oxygen Therapy: Oxygen therapy may be provided using a mask, nasal cannula, or positive pressure mask to help increase the amount of oxygen in the blood. […] Continuous Positive Airway Pressure (CPAP): CPAP therapy involves using a machine that delivers a continuous flow of air pressure to the lungs through a mask. It helps reduce the amount of fluid in the lungs and improve breathing.

• #17 Pulmonary Edema: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24218-pulmonary-edema

  Pulmonary edema is a serious condition. If you have sudden (acute) pulmonary edema, you need immediate treatment. You may need to be treated in the emergency room (ER) or intensive care unit (ICU). […] Some treatment options include: Oxygen delivered through prongs in your nose. Machines that blow air into your lungs through a mask on your face. Ventilators or respirators that blow in air through a tube inserted into your windpipe. Medications that cause you to urinate more and get rid of fluid or which strengthen your heart. Other medications, when congestive heart failure isn’t the cause of your pulmonary edema, such as antibiotics and steroids. […] If you have acute (sudden) pulmonary edema, you need immediate treatment. You may be treated in the emergency room (ER) or intensive care unit (ICU). Chronic pulmonary edema may require hospitalization as well.

• #18 Pulmonary Edema: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/pulmonary-edema

  A machine will deliver oxygen under pressure to help get more air into your lungs. Sometimes this can be done with a mask or cannula, also called continuous positive airway pressure (CPAP). […] Your doctor may need to insert an endotracheal tube, or breathing tube, down your throat and use mechanical ventilation. […] Pulmonary edema requires prompt medical treatment.

• #19 Pulmonary edema – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_edema

  Continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) has been demonstrated to reduce mortality and the need of mechanical ventilation in people with severe cardiogenic pulmonary edema. […] It is possible for cardiogenic pulmonary edema to occur together with cardiogenic shock, in which the cardiac output is insufficient to sustain an adequate blood pressure to the lungs. This can be treated with inotropic agents or by intra-aortic balloon pump, but this is regarded as temporary treatment while the underlying cause is addressed and the lungs recover. […] Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. […] Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension. […] While this effect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent (acclimatization) has been delayed for some reason.

• #20 Pulmonary Oedema—Therapeutic Targets

  https://www.cfrjournal.com/articles/pulmonary-oedema-therapeutic-targets?language_content_entity=en

  Although, recent clinical registries have suggested the majority of patients admitted with PO rapidly improve as a result of conventional IV therapies, treatment of PO remains largely opinion-based as there is a general lack of good evidence to guide therapy. […] In clinical practice, acute management of PO is based on IV opiates, diuretics, vasodilators, inotropes, and MV. […] Intravenous loop diuretics are an essential component of PO treatment, and recent guidelines consider IV diuretics as first-line therapy. […] According to recent guidelines, vasodilators may be considered as an adjuvant to diuretic therapy for dyspnea relief when SBP remains 110 mmHg. […] The majority of patients admitted with PO have pulmonary congestion related to high LV filling pressures. […] The objectives of MV, either invasive or noninvasive, are to improve oxygenation, to reduce work of breathing, to move alveolar and interstitial fluids into capillaries, to reverse respiratory acidosis and hypercapnia, and finally to improve tissue perfusion.

• #21 Pulmonary Oedema—Therapeutic Targets

  https://www.cfrjournal.com/articles/pulmonary-oedema-therapeutic-targets?language_content_entity=en

  NIMV may be considered as adjunctive therapy in patients with PO who have severe respiratory distress or whose condition does not improve with pharmacologic therapy. […] Future research is required to develop innovative pharmacotherapies capable of relieving hemodynamic congestion while simultaneously preserving end-organ function.

• #22 Managing acute pulmonary oedema – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/managing-acute-pulmonary-oedema.html

  Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema. There has therefore been a shift over the last few years to favour nitrates and non-invasive ventilation as first-line management.

• #23 Pulmonary edema – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_edema

  Continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) has been demonstrated to reduce mortality and the need of mechanical ventilation in people with severe cardiogenic pulmonary edema. […] It is possible for cardiogenic pulmonary edema to occur together with cardiogenic shock, in which the cardiac output is insufficient to sustain an adequate blood pressure to the lungs. This can be treated with inotropic agents or by intra-aortic balloon pump, but this is regarded as temporary treatment while the underlying cause is addressed and the lungs recover. […] Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. […] Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension. […] While this effect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent (acclimatization) has been delayed for some reason.

• #24 Latest on Congestive Heart Failure and Pulmonary Edema

  https://www.uscjournal.com/articles/current-thinking-acute-congestive-heart-failure-and-pulmonary-edema?language_content_entity=en

  Recent data comparing nasal CPAP therapy with facemask ventilation therapy has demonstrated a decreased need for intubation rates when these modalities are used. In patients with severe CHF treated with CPAP, however, no significant difference was found in short-term mortality and hospital stay. Although BiPAP therapy may improve ventilation and vital signs more rapidly than CPAP, a higher incidence of MI associated with BiPAP has been reported. BiPAP and CPAP are contraindicated in the presence of acute facial trauma, the absence of an intact airway, and in patients with an altered mental status or who are uncooperative. […] The goal of pharmacotherapy is to achieve a PCWP of 15-18mmHg and a cardiac index 2.2L/min/m2, while maintaining adequate blood pressure and perfusion to essential organs. These goals may need to be modified for some patients.

• #25 High-flow oxygen therapy for treating re-expansion pulmonary edema

  https://atm.amegroups.org/article/view/26066/html

  Re-expansion pulmonary edema (REPE) is a lethal complication, which usually occurs after rapid re-expansion of a collapsed lung following chest tube insertion. […] A high-flow nasal cannula can supply a high concentration of oxygen while maintaining spontaneous breathing in patients with dyspnea, which has recently emerged as an alternative to ventilators. […] The results indicated that use of a high-flow nasal cannula in REPE is advantageous compared to mechanical ventilation. […] Therefore, to overcome the initial phenomena associated with ventilator use, it is necessary to supply a high concentration of oxygen using spontaneous ventilation where possible. […] The high-flow nasal cannula is able to deliver a consistent oxygen supply to the alveoli by constantly applying positive pressure, enabling the patient to maintain a high level of oxygen supply comparable to that obtained using a ventilator.

• #26 Benefits of High-Flow Nasal Cannula Therapy for Acute Pulmonary Edema in Patients with Heart Failure in the Emergency Department: A Prospective Multi-Center Randomized Controlled Trial

  https://www.mdpi.com/2077-0383/9/6/1937

  Heart failure patients with pulmonary edema presenting to the emergency department (ED) require an effective approach to deliver sufficient oxygen and reduce the rate of intubation and mechanical ventilation in the ED; conventional oxygen therapy has proven ineffective in delivering enough oxygen to the tissues. […] HFNC therapy could therefore be considered as initial oxygen therapy. Physicians may consider advanced ventilation if there is no significant improvement in ABG parameters within 30 min of HFNC therapy. […] The application of HFNC therapy significantly improved oxygenation and decreased the RR in patients with respiratory failure. […] The use of appropriate oxygen therapy can reduce the rate of intubation and mechanical ventilation in the ED. […] Compared with conventional oxygen therapy, HFNC therapy could significantly improve several objective parameters over time such as RR, lactate levels, and ABG reflection of oxygenation and ventilation after ED admission in HF patients with acute pulmonary edema. The application of HFNC therapy could replace conventional O2 therapy as initial effective oxygen therapy in patients with cardiogenic pulmonary edema in the ED. In addition, we suggest that physicians consider advanced ventilation devices if there is no significant improvement in several parameters in ABGA after HFNC therapy in patients with cardiogenic pulmonary edema.

• #27 High-flow oxygen therapy for treating re-expansion pulmonary edema

  https://atm.amegroups.org/article/view/26066/html

  Considering the clinical features of REPE, we felt that it would be better to apply the high-flow nasal cannula than NIV or a ventilator. […] High-flow nasal cannulas can be used to treat patients without ventilator care, thus reducing the duration of treatment. […] In conclusion, the high-flow nasal cannula, which is widely used for the treatment of respiratory distress, is effective for treatment of REPE because it allows spontaneous breathing while maintaining positive pressure in stable alveoli, and a stable supply of a high concentration of oxygen.

• #28 Benefits of High-Flow Nasal Cannula Therapy for Acute Pulmonary Edema in Patients with Heart Failure in the Emergency Department: A Prospective Multi-Center Randomized Controlled Trial

  https://www.mdpi.com/2077-0383/9/6/1937

  Heart failure patients with pulmonary edema presenting to the emergency department (ED) require an effective approach to deliver sufficient oxygen and reduce the rate of intubation and mechanical ventilation in the ED; conventional oxygen therapy has proven ineffective in delivering enough oxygen to the tissues. […] HFNC therapy could therefore be considered as initial oxygen therapy. Physicians may consider advanced ventilation if there is no significant improvement in ABG parameters within 30 min of HFNC therapy. […] The application of HFNC therapy significantly improved oxygenation and decreased the RR in patients with respiratory failure. […] The use of appropriate oxygen therapy can reduce the rate of intubation and mechanical ventilation in the ED. […] Compared with conventional oxygen therapy, HFNC therapy could significantly improve several objective parameters over time such as RR, lactate levels, and ABG reflection of oxygenation and ventilation after ED admission in HF patients with acute pulmonary edema. The application of HFNC therapy could replace conventional O2 therapy as initial effective oxygen therapy in patients with cardiogenic pulmonary edema in the ED. In addition, we suggest that physicians consider advanced ventilation devices if there is no significant improvement in several parameters in ABGA after HFNC therapy in patients with cardiogenic pulmonary edema.

• #29 Pulmonary edema: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000140.htm

  Pulmonary edema is almost always treated in the emergency room or hospital. You may need to be in an intensive care unit (ICU). […] Oxygen is given through a face mask or tiny plastic tubes are placed in the nose. […] A breathing tube may be placed into the windpipe (trachea) so you can be connected to a breathing machine (ventilator) if you cannot breathe well on your own (only needed in severe cases). […] The cause of pulmonary edema should be identified and treated quickly. For example, if a heart attack has caused the condition, it must be treated right away. […] Medicines that may be used include: […] Diuretics that remove excess fluid from the body […] Medicines that strengthen the heart muscle, control the heartbeat, or relieve pressure on the heart […] Other medicines when heart failure is not the cause of the pulmonary edema.

• #30 What Is Pulmonary Edema? Symptoms, Risk Factors & Treatment

  https://www.emedicinehealth.com/pulmonary_edema/article_em.htm

  What Medications Can Help Treat Pulmonary Edema? Oxygen: In acute cases, oxygen is the first drug that may help reduce dyspnea or shortness of breath. Intravenous diuretics: Intravenous diuretics [furosemide (Lasix), bumetanide (Bumex)] are first-line medications to help the kidneys remove excess fluid from the body. Even in kidney failure, these drugs may help shift fluid out of the lung for a short period of time. Medications to reduce the workload of the heart: Reducing the effort of the heart may be helpful in acute situations. Nitroglycerin (Nitrolingual, Nitrolingual Duo Pack, Nitroquick, Nitrostat) can be used to reduce the workload of the heart by dilating blood vessels and reducing the amount of blood returning to the heart. Enalapril (Vasotec) and captopril (Capoten) are examples of medications that dilate peripheral arteries and decrease the resistance against which the heart muscle must pump. Morphine: Morphine may be considered to ease anxiety and help with the feeling of shortness of breath. Positive airway pressure breathing machines: If the patient is in respiratory failure, positive airway pressure breathing machines (CPAP, BiPAP) may be used to force air into the lungs. This is a short-term solution (used for up to a few hours) until the medications work. Intubation: In patients who become somnolent (sleepy) or who are no longer able to breathe adequately on their own, intubation (putting a tube into the airway) and using a ventilator may be required. Mechanical ventilation: In non-cardiogenic pulmonary edema, the focus will be on decreasing lung inflammation. While the above medications may be considered, the short-term use of mechanical ventilation with CPAP, BiPAP, or a ventilator may be indicated. The underlying cause of pulmonary edema needs to be diagnosed, and this will direct further therapy.

• #31 Acute Pulmonary Edema: Emergency Care Algorithm – Should We Remove or Redistribute the Fluid? | ClinCaseQuest

  https://clincasequest.hospital/acute-pulmonary-edema/

  Inotropic agents should be initiated only when hypotension is present with reduced organ perfusion. In such cases, dobutamine is usually the first-line treatment. […] Diuretics are indicated only for patients who exhibit signs of fluid overload. Intravenous administration of furosemide in doses of 40 to 80 mg is preferred. […] Morphine was traditionally part of the treatment regimen for acute pulmonary edema due to its ability to reduce shortness of breath. However, the use of morphine carries several side effects, including respiratory and central nervous system depression, decreased cardiac output, and hypotension. […] The first step in improving ventilation for patients with acute pulmonary edema is to ensure they are in a sitting position, which helps reduce the ventilation-perfusion mismatch. […] If persistent hypercapnia, hypoxemia, or acidosis occurs despite noninvasive ventilation, intubation should be considered.

• #32 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  The initial management of patients with cardiogenic pulmonary edema (CPE) should address the ABCs of resuscitation, that is, airway, breathing, and circulation. Oxygen should be administered to all patients to keep oxygen saturation at greater than 90%. Any associated arrhythmia or MI should be treated appropriately. […] Following initial management, medical treatment of CPE focuses on 3 main goals: (1) reduction of pulmonary venous return (preload reduction), (2) reduction of systemic vascular resistance (afterload reduction), and, in some cases, (3) inotropic support. Preload reduction decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation into the pulmonary interstitium and alveoli. Afterload reduction increases cardiac output and improves renal perfusion, which allows for diuresis in the patient with fluid overload.

• #33 Pulmonary Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema

  Treatment is with oxygen, IV nitrates, diuretics, and, in patients with heart failure and reduced ejection fraction, sometimes short-term IV positive inotropes and assisted ventilation (ie, endotracheal intubation with mechanical ventilation or bilevel positive airway pressure ventilation). […] Initial treatment of pulmonary edema includes identifying the cause; 100% oxygen by nonrebreather mask; upright position; furosemide 0.5 to 1.0 mg/kg IV or by continuous infusion 5 to 10 mg/hour; nitroglycerin 0.4 mg sublingually every 5 minutes, followed by an IV drip at 10 to 20 mcg/minute, titrated upward at 10 mcg/minute every 5 minutes as needed to a maximum 300 mcg/minute if systolic blood pressure is 100 mm Hg. Morphine, 1 to 5 mg IV once or twice, has long been used to reduce severe anxiety and the work of breathing but is decreasingly used (except in palliative care) due to observational studies suggesting a poorer outcome with its use. Noninvasive ventilatory assistance with bilevel positive airway pressure (BiPAP) is helpful if hypoxia is significant. If carbon dioxide retention is present or the patient is obtunded, tracheal intubation and mechanical ventilation are required.

• #34 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  Ventilation is a nonpharmacologic intervention that aims to increase oxygenation, move fluids back into the capillaries, and reverse respiratory acidosis. It is typically reserved for patients with oxygen saturation (SpO2) less than 92%. […] Intensive care is required for patients with pulmonary edema who require intubation; have symptoms of hypoperfusion; have an SpO2 less than 90% while on oxygen; have a heart rate less than 40 bpm or greater than 130 bpm; and/or have a systolic blood pressure 90 mm Hg. […] Hospitalized patients with pulmonary edema should have their weight, serum electrolytes, and renal function monitored daily. Individual medications and side effects to monitor include: […] The potential for drug interactions should be considered if new medications are started in the inpatient setting to treat the underlying cause of pulmonary edema. Importantly, nitrates should not be administered to patients who have received treatment with a phosphodiesterase inhibitor, such as sildenafil, within the previous 24 hours.

• #35 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Mechanical ventilation maximizes myocardial oxygen delivery and ventilation. Positive end-expiratory pressure is generally recommended to increase alveolar patency and to enhance oxygen delivery and carbon dioxide exchange. […] Nitroglycerin (NTG) is the most effective, predictable, and rapidly-acting medication available for preload reduction. […] Loop diuretics have been considered the cornerstone of CPE treatment for many years. Furosemide is used most commonly. […] The use of morphine sulfate in CPE for preload reduction has been commonplace for many years, but good evidence supporting a beneficial hemodynamic effect is lacking. […] Nesiritide is recombinant human BNP that decreases PCWP, pulmonary artery pressure, RA pressure, and systemic vascular resistance while increasing the cardiac index and stroke volume index.

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• #37 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #38 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  The drugs used in treatment include nitrates, diuretics, morphine and inotropes. Some patients will require ventilatory support. […] Despite the widespread use of nitrates in acute pulmonary oedema, there is a lack of high-quality evidence to support this practice. […] There is a lack of controlled studies showing that diuretics are of benefit in acute pulmonary oedema. However, diuretics are indicated for patients with evidence of fluid overload. […] Morphine is therefore no longer recommended for routine use in acute pulmonary oedema. […] If required, oxygen should be administered to achieve a target oxygen saturation of 92-96%. […] Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema.

• #39 Pulmonary Edema > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/pulmonary-edema

  Treatment includes supplemental oxygen, medications, mechanical ventilation, renal replacement therapy […] Common treatments for pulmonary edema include: Supplemental oxygen, may be delivered via a nasal cannula; Medications, including diuretics (to rid the body of excess fluid); nitroglycerin (to help lower pressure within the heart); inotropes (to help the heart pump more efficiently); and/or ACE inhibitors (to manage blood pressure levels); Morphine, which can help reduce anxiety and improve breathing; Continuous Positive Airway Pressure (CPAP), another method to improve breathing; Ventilators, which require intubation, may improve breathing when other methods are unsuccessful; Renal replacement therapy, when pulmonary edema causes kidney failure. […] Fortunately, pulmonary edema is a reversible condition, and the faster it is treated, the better the outcome is likely to be, says Yale Medicine pulmonologist Isabel Bazan, MD.

• #40 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #41 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  The treatment goals in pulmonary edema are to correct the underlying cause and lessen the symptoms of fluid accumulation. Treatment for pulmonary edema should include: […] Loop diuretics such as furosemide, torsemide, bumetanide, and ethacrynic acid are the treatment of choice to decrease fluid overload. The following dosages of furosemide are recommended for patients with pulmonary edema: […] Intravenous nitroglycerin may be added to lessen pulmonary congestion. It may be used if the patient has chest pain and a systolic blood pressure greater than 90 mm Hg. Dosing of nitroglycerin for pulmonary edema is as follows: […] Patients with low systolic blood pressure and lack of perfusion to the tissues may require treatment with dobutamine or dopamine. Dosages for these agents in the setting of pulmonary edema are as follows:

• #42 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #43 NHSAAA Medicines – Management of Acute Pulmonary Oedema / Heart Failure

  https://aaamedicines.org.uk/guidelines/cardiovascular-system/management-of-acute-pulmonary-oedema-heart-failure/

  For early or mild pulmonary oedema (crackles and upper lobe venous diversion): give high flow oxygen (5-10L/minute; also refer to Guidelines on Oxygen and Oximetry), loop diuretic (furosemide IV or oral 40mg) and review precipitating factors. […] For severe pulmonary oedema follow advice below: Sit patient upright and give high flow oxygen (5-10L/minute). Also refer to Guidelines on Oxygen and Oximetry. […] IV loop diuretic (furosemide IV 40-80mg or higher if previously on diuretic). If no diuresis and patient not improving 30 minutes post-IV diuretic: Repeat diuretic (if necessary consider furosemide infusion). […] Give IV nitrate if blood pressure permits. […] Consider IV dobutamine (5-10micrograms/kg/min) under senior/specialist advice – discuss with cardiologist or consultant. […] If arterial saturations are poor, consider CPAP. […] In patients unable to maintain respiratory effort ventilation should be considered and where appropriate discussed with consultant and ITU. […] Once the acute episode is resolved and the patient is more stable consider long-term management below.

• #44 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  The treatment goals in pulmonary edema are to correct the underlying cause and lessen the symptoms of fluid accumulation. Treatment for pulmonary edema should include: […] Loop diuretics such as furosemide, torsemide, bumetanide, and ethacrynic acid are the treatment of choice to decrease fluid overload. The following dosages of furosemide are recommended for patients with pulmonary edema: […] Intravenous nitroglycerin may be added to lessen pulmonary congestion. It may be used if the patient has chest pain and a systolic blood pressure greater than 90 mm Hg. Dosing of nitroglycerin for pulmonary edema is as follows: […] Patients with low systolic blood pressure and lack of perfusion to the tissues may require treatment with dobutamine or dopamine. Dosages for these agents in the setting of pulmonary edema are as follows:

• #45 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  The treatment goals in pulmonary edema are to correct the underlying cause and lessen the symptoms of fluid accumulation. Treatment for pulmonary edema should include: […] Loop diuretics such as furosemide, torsemide, bumetanide, and ethacrynic acid are the treatment of choice to decrease fluid overload. The following dosages of furosemide are recommended for patients with pulmonary edema: […] Intravenous nitroglycerin may be added to lessen pulmonary congestion. It may be used if the patient has chest pain and a systolic blood pressure greater than 90 mm Hg. Dosing of nitroglycerin for pulmonary edema is as follows: […] Patients with low systolic blood pressure and lack of perfusion to the tissues may require treatment with dobutamine or dopamine. Dosages for these agents in the setting of pulmonary edema are as follows:

• #46 Pulmonary Edema – What You Need to Know

  https://www.drugs.com/cg/pulmonary-edema.html

  How is pulmonary edema treated? Treatment will depend on what caused your pulmonary edema. If high altitude caused your pulmonary edema, your symptoms may go away when you go to a lower altitude. You may also need any of the following: […] Medicines may be given to remove extra fluid from around your lungs or decrease your blood pressure. Heart medicines may also be given to make your heartbeat stronger or more regular. […] Breathing support may help you breathe better and decrease the pressure in your lungs. You may need extra oxygen. You may also need to use a machine, such as a noninvasive positive-pressure ventilation (NPPV) or a ventilator. An NPPV is a machine that helps your lungs fill with air. A ventilator is a machine that can breathe for you if you cannot breathe well on your own. […] The following list of medications are related to or used in the treatment of this condition: furosemide, Lasix, Bumex, Edecrin, Sodium Edecrin.

• #47 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  The drugs used in treatment include nitrates, diuretics, morphine and inotropes. Some patients will require ventilatory support. […] Despite the widespread use of nitrates in acute pulmonary oedema, there is a lack of high-quality evidence to support this practice. […] There is a lack of controlled studies showing that diuretics are of benefit in acute pulmonary oedema. However, diuretics are indicated for patients with evidence of fluid overload. […] Morphine is therefore no longer recommended for routine use in acute pulmonary oedema. […] If required, oxygen should be administered to achieve a target oxygen saturation of 92-96%. […] Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema.

• #48 Furosemide in the Treatment of Acute Pulmonary Edema – emDocs

  https://www.emdocs.net/furosemide-treatment-acute-pulmonary-edema/

  Bottom line: Vascular congestion does not equal volume overload. More than 50% of cases of APE are not associated to significant volume overload. […] Bottom Line: Loop diuretics are harmful early in the management of APE. […] Immediate care should focus on NIPPV and administration of nitroglycerin. […] In patients with ESRD, dialysis is what’s ultimately going to fix the patient.

• #49 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #50 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Mechanical ventilation maximizes myocardial oxygen delivery and ventilation. Positive end-expiratory pressure is generally recommended to increase alveolar patency and to enhance oxygen delivery and carbon dioxide exchange. […] Nitroglycerin (NTG) is the most effective, predictable, and rapidly-acting medication available for preload reduction. […] Loop diuretics have been considered the cornerstone of CPE treatment for many years. Furosemide is used most commonly. […] The use of morphine sulfate in CPE for preload reduction has been commonplace for many years, but good evidence supporting a beneficial hemodynamic effect is lacking. […] Nesiritide is recombinant human BNP that decreases PCWP, pulmonary artery pressure, RA pressure, and systemic vascular resistance while increasing the cardiac index and stroke volume index.

• #51 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  The treatment goals in pulmonary edema are to correct the underlying cause and lessen the symptoms of fluid accumulation. Treatment for pulmonary edema should include: […] Loop diuretics such as furosemide, torsemide, bumetanide, and ethacrynic acid are the treatment of choice to decrease fluid overload. The following dosages of furosemide are recommended for patients with pulmonary edema: […] Intravenous nitroglycerin may be added to lessen pulmonary congestion. It may be used if the patient has chest pain and a systolic blood pressure greater than 90 mm Hg. Dosing of nitroglycerin for pulmonary edema is as follows: […] Patients with low systolic blood pressure and lack of perfusion to the tissues may require treatment with dobutamine or dopamine. Dosages for these agents in the setting of pulmonary edema are as follows:

• #52 Latest on Congestive Heart Failure and Pulmonary Edema

  https://www.uscjournal.com/articles/current-thinking-acute-congestive-heart-failure-and-pulmonary-edema?language_content_entity=en

  Use of diuretics, nitrates, analgesics, and inotropic agents are indicated for the treatment of CHF and pulmonary edema. Calcium channel blockers, such as nifedipine and nondihydropyridines, increase mortality and increase incidence of recurrent CHF with chronic use. […] First-line therapy generally includes a loop diuretic such as furosemide, which will inhibit sodium chloride reabsorption in the ascending loop of Henle. Loop diuretics should be administered IV, since this allows for both superior potency and higher peak concentration despite increased incidence of side-effects, particularly ototoxicity. Higher doses and more rapid redosing may be appropriate for the patient in severe distress. […] Nitrates reduce myocardial oxygen demand by lowering preload and afterload. Nitroglycerin is particularly useful in the patient who presents with acute pulmonary edema with a systolic blood pressure of at least 100mmHg.

• #53 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #54 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  ACE inhibitors are generally considered the cornerstones for treating chronic CHF, and studies have demonstrated excellent results with ACE inhibitors for the treatment of acute decompensated CHF and CPE. […] Nitroprusside results in simultaneous preload and afterload reduction by causing direct smooth-muscle relaxation, with an increased effect on afterload. […] Inotropic support is usually used when preload- and afterload-reduction strategies are not successful or when hypotension precludes the use of these strategies. […] Levosimendan is a calcium sensitizer that is used in several European countries to manage moderate to severe heart failure. […] Ultrafiltration (UF) is a method of fluid removal that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] After the patient’s condition has been stabilized, further inpatient care depends on the underlying cause of the episode of CPE. […] Transfer of patients to a tertiary receiving hospital is generally indicated if the initial hospital lacks adequate resources to care for the patient.

• #55 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #56 Managing acute pulmonary oedema – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/managing-acute-pulmonary-oedema.html

  Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema. There has therefore been a shift over the last few years to favour nitrates and non-invasive ventilation as first-line management.

• #57 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #58 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  ACE inhibitors are generally considered the cornerstones for treating chronic CHF, and studies have demonstrated excellent results with ACE inhibitors for the treatment of acute decompensated CHF and CPE. […] Nitroprusside results in simultaneous preload and afterload reduction by causing direct smooth-muscle relaxation, with an increased effect on afterload. […] Inotropic support is usually used when preload- and afterload-reduction strategies are not successful or when hypotension precludes the use of these strategies. […] Levosimendan is a calcium sensitizer that is used in several European countries to manage moderate to severe heart failure. […] Ultrafiltration (UF) is a method of fluid removal that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] After the patient’s condition has been stabilized, further inpatient care depends on the underlying cause of the episode of CPE. […] Transfer of patients to a tertiary receiving hospital is generally indicated if the initial hospital lacks adequate resources to care for the patient.

• #59 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  The drugs used in treatment include nitrates, diuretics, morphine and inotropes. Some patients will require ventilatory support. […] Despite the widespread use of nitrates in acute pulmonary oedema, there is a lack of high-quality evidence to support this practice. […] There is a lack of controlled studies showing that diuretics are of benefit in acute pulmonary oedema. However, diuretics are indicated for patients with evidence of fluid overload. […] Morphine is therefore no longer recommended for routine use in acute pulmonary oedema. […] If required, oxygen should be administered to achieve a target oxygen saturation of 92-96%. […] Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema.

• #60 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  The treatment goals in pulmonary edema are to correct the underlying cause and lessen the symptoms of fluid accumulation. Treatment for pulmonary edema should include: […] Loop diuretics such as furosemide, torsemide, bumetanide, and ethacrynic acid are the treatment of choice to decrease fluid overload. The following dosages of furosemide are recommended for patients with pulmonary edema: […] Intravenous nitroglycerin may be added to lessen pulmonary congestion. It may be used if the patient has chest pain and a systolic blood pressure greater than 90 mm Hg. Dosing of nitroglycerin for pulmonary edema is as follows: […] Patients with low systolic blood pressure and lack of perfusion to the tissues may require treatment with dobutamine or dopamine. Dosages for these agents in the setting of pulmonary edema are as follows:

• #61 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  ACE inhibitors are generally considered the cornerstones for treating chronic CHF, and studies have demonstrated excellent results with ACE inhibitors for the treatment of acute decompensated CHF and CPE. […] Nitroprusside results in simultaneous preload and afterload reduction by causing direct smooth-muscle relaxation, with an increased effect on afterload. […] Inotropic support is usually used when preload- and afterload-reduction strategies are not successful or when hypotension precludes the use of these strategies. […] Levosimendan is a calcium sensitizer that is used in several European countries to manage moderate to severe heart failure. […] Ultrafiltration (UF) is a method of fluid removal that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] After the patient’s condition has been stabilized, further inpatient care depends on the underlying cause of the episode of CPE. […] Transfer of patients to a tertiary receiving hospital is generally indicated if the initial hospital lacks adequate resources to care for the patient.

• #62 Pulmonary Edema: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/pulmonary-edema-nursing-diagnosis-care-plan/

  Treatment options may include one or more of the following drugs, depending on the severity and cause of the pulmonary edema: Diuretics, Vasodilators, Inotropes, Morphine. […] The first line of treatment for high-altitude pulmonary edema (HAPE) is applying oxygen. If a portable hyperbaric chamber is available, this can imitate moving to a lower elevation. […] Adherence to treatment regimens is crucial to prevent the development of pulmonary edema. […] Avoiding drug use or high altitudes can help prevent further lung damage. […] Diuretics continue to be the cornerstone of pulmonary edema treatment. […] The recommended vasodilator is IV nitroglycerin, which reduces lung congestion and preload. […] High-altitude pulmonary edema is prevented and treated with nifedipine. […] Inotropes such as dobutamine and dopamine are administered to treat pulmonary edema with tissue hypoperfusion.

• #63 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms. […] A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure. […] Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications: […] Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs. […] Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

• #64 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Mechanical ventilation maximizes myocardial oxygen delivery and ventilation. Positive end-expiratory pressure is generally recommended to increase alveolar patency and to enhance oxygen delivery and carbon dioxide exchange. […] Nitroglycerin (NTG) is the most effective, predictable, and rapidly-acting medication available for preload reduction. […] Loop diuretics have been considered the cornerstone of CPE treatment for many years. Furosemide is used most commonly. […] The use of morphine sulfate in CPE for preload reduction has been commonplace for many years, but good evidence supporting a beneficial hemodynamic effect is lacking. […] Nesiritide is recombinant human BNP that decreases PCWP, pulmonary artery pressure, RA pressure, and systemic vascular resistance while increasing the cardiac index and stroke volume index.

• #65 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #66 Managing acute pulmonary oedema – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/managing-acute-pulmonary-oedema.html

  The drugs used in treatment include nitrates, diuretics, morphine and inotropes. Some patients will require ventilatory support. […] Despite the widespread use of nitrates in acute pulmonary oedema, there is a lack of high-quality evidence to support this practice. […] There is a lack of controlled studies showing that diuretics are of benefit in acute pulmonary oedema. However, diuretics are indicated for patients with evidence of fluid overload. […] Morphine has been part of the traditional treatment for acute pulmonary oedema as it can reduce dyspnoea. […] In the absence of high-quality randomised trial data, the best current evidence suggests that morphine may cause harm. Morphine is therefore no longer recommended for routine use in acute pulmonary oedema. […] If required, oxygen should be administered to achieve a target oxygen saturation of 92-96%.

• #67

  https://link.springer.com/article/10.1007/s40138-017-0131-8

  We will review the pharmacodynamics and clinical outcomes of morphine therapy for pulmonary oedema. […] Morphine, along with furosemide and nitrates, is routinely used to treat cardiogenic pulmonary oedema. Clinical data on the safety and efficacy of morphine for cardiogenic pulmonary oedema are scarce; however, morphine use has been correlated with increased rates of ICU admission and mechanical ventilation. European and American heart failure guidelines do not recommend routine use of morphine for cardiogenic pulmonary oedema. […] Morphine is of questionable benefit and may be harmful in treatment of acute pulmonary oedema. Clinical guidelines do not encourage routine use of morphine for pulmonary oedema; other medications for anxiolysis and vasodilation may be preferable. […] Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. […] The largest and most recent investigation linking morphine usage for CPE to mechanical ventilation (15.4 vs 2.8%), median hospitalisation (5.6 vs 4.2 days), ICU admissions, and mortality (13.0 vs 2.4%). […] Morphine should be abandoned as a treatment for acute cardiogenic pulmonary oedema.

• #68 Sympathetic Crashing Acute Pulmonary Edema (SCAPE) – EMCrit Project

  https://emcrit.org/ibcc/scape/

  Transition to oral antihypertensives: […] SCAPE can often resolve rapidly, with swift drops in BP. Starting oral antihypertensive too soon may lead to rebound hypotension. […] Opioid: […] Retrospective studies have correlated the use of morphine with worse outcomes among patients with pulmonary edema. This shouldn’t be surprising.

• #69

  https://consensus.app/questions/treatment-for-pulmonary-edema/

  Pulmonary edema, characterized by excess fluid in the lungs, can result from various underlying conditions such as heart failure, increased vascular permeability, or high pulmonary capillary pressure. Effective treatment aims to relieve hypoxemia and reduce pulmonary capillary pressure, employing both pharmacological and non-pharmacological strategies. […] Nitroprusside and nitroglycerin are vasodilators that have shown efficacy in reducing pulmonary capillary pressure and alleviating pulmonary edema. In a study involving dogs, nitroprusside significantly reduced edema by lowering hydrostatic pressure without compromising cardiac output. Similarly, nitroglycerin has been found beneficial in pre-hospital settings, improving patient outcomes more effectively than morphine and furosemide. […] High-dose intravenous isosorbide-dinitrate (ISDN) has been demonstrated to be safer and more effective than bilevel positive airway pressure (BiPAP) ventilation in treating severe pulmonary edema. Patients treated with ISDN showed better oxygen saturation and fewer adverse events compared to those receiving BiPAP.

• #70 Pulmonary edema: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000140.htm

  Pulmonary edema is almost always treated in the emergency room or hospital. You may need to be in an intensive care unit (ICU). […] Oxygen is given through a face mask or tiny plastic tubes are placed in the nose. […] A breathing tube may be placed into the windpipe (trachea) so you can be connected to a breathing machine (ventilator) if you cannot breathe well on your own (only needed in severe cases). […] The cause of pulmonary edema should be identified and treated quickly. For example, if a heart attack has caused the condition, it must be treated right away. […] Medicines that may be used include: […] Diuretics that remove excess fluid from the body […] Medicines that strengthen the heart muscle, control the heartbeat, or relieve pressure on the heart […] Other medicines when heart failure is not the cause of the pulmonary edema.

• #71 Pulmonary edema (Fluid in the lungs): Causes, symptoms, and more

  https://www.medicalnewstoday.com/articles/167533

  Diuretics are the most commonly used medication and can help reduce fluid buildup by increasing the production of urine. […] Depending on the specific cause and a persons symptoms, a healthcare professional may use any of the following other medications to treat pulmonary edema: Vasodilators: These medications dilate the blood vessels to decrease pulmonary congestion. […] Calcium channel blockers: These help reduce high blood pressure. […] Inotropes: This type of medication can increase the force of heart muscle contractions so that the heart can pump blood throughout the body. […] Morphine: This medication can help reduce anxiety and shortness of breath. However, because of its potential risks, healthcare professionals do not often recommend it.

• #72 Pulmonary Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema

  Specific additional treatment depends on etiology: For acute myocardial infarction or another acute coronary syndrome, thrombolysis or direct percutaneous coronary angioplasty with or without stent placement. For severe hypertension, an IV vasodilator. For supraventricular or ventricular tachycardia, direct-current cardioversion. For rapid atrial fibrillation, cardioversion is preferred. To slow the ventricular rate, an IV beta-blocker, IV digoxin, or cautious use of an IV calcium channel blocker. […] Once patients are stabilized, long-term HF treatment is begun.

• #73 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema

  Cardiogenic pulmonary edema is a life-threatening accumulation of excess fluid in your lungs because of pressure in your heart. Medications can get rid of the extra fluid, but your healthcare provider may need to do procedures as well. Treatments vary depending on the cause. The outlook for this problem depends on whats causing your edema. […] Procedures or invasive treatments for cardiac edema include: Percutaneous coronary intervention (PCI). Ventricular assist device. Heart valve replacement. Coronary artery bypass graft. Intra-aortic balloon pump (IABP), which helps your heart pump better. Extracorporeal membrane oxygenation (ECMO). Heart transplant. […] Your healthcare provider may prescribe: Vasodilators to widen your blood vessels. Diuretics to help you get more fluids out of your body.

• #74 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  Immediately going down to a lower elevation. For someone in high altitudes who has mild symptoms of high-altitude pulmonary edema (HAPE), going down 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as possible can help. Someone with severe HAPE might need rescue assistance to get off the mountain. […] Stopping exercise and staying warm. Physical activity and cold can make pulmonary edema worse. […] Medication. Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help treat or prevent symptoms of HAPE. To prevent HAPE, they start taking the medication at least a day before going higher.

• #75 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. […] Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications. […] Immediate treatment is necessary for acute pulmonary edema to prevent death. […] To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 meters) a day once you reach 8,200 feet (about 2,500 meters). […] Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

• #76 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  Immediately going down to a lower elevation. For someone in high altitudes who has mild symptoms of high-altitude pulmonary edema (HAPE), going down 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as possible can help. Someone with severe HAPE might need rescue assistance to get off the mountain. […] Stopping exercise and staying warm. Physical activity and cold can make pulmonary edema worse. […] Medication. Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help treat or prevent symptoms of HAPE. To prevent HAPE, they start taking the medication at least a day before going higher.

• #77 Pulmonary edema – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/pulmonary-edema/

  As with other forms of pulmonary edema, oxygen is the usually the first treatment. If supplemental oxygen isn’t available, you may use portable hyperbaric chambers, which imitate a descent for several hours until you are able to move to a lower elevation. […] Treatments for high-altitude pulmonary edema (HAPE) also include: Immediately descending to a lower elevation. If you’re climbing or traveling at high altitudes and have mild symptoms of HAPE, descend 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as you can, within reason. Depending on the severity of your condition, you may need rescue assistance to get off the mountain.

• #78 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  Immediately going down to a lower elevation. For someone in high altitudes who has mild symptoms of high-altitude pulmonary edema (HAPE), going down 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as possible can help. Someone with severe HAPE might need rescue assistance to get off the mountain. […] Stopping exercise and staying warm. Physical activity and cold can make pulmonary edema worse. […] Medication. Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help treat or prevent symptoms of HAPE. To prevent HAPE, they start taking the medication at least a day before going higher.

• #79 High-Altitude Pulmonary Edema (HAPE) Treatment & Management: Approach Considerations, Medical Care, Prevention

  https://emedicine.medscape.com/article/300716-treatment

  Educate travelers with the following three Centers for Disease Control and Prevention (CDC) principles to prevent death or serious consequences from altitude illness: Know the early symptoms of altitude illness, and be willing to acknowledge when they are present. Never ascend to sleep at a higher altitude when experiencing symptoms of altitude illness, no matter how minor they seem. Descend if the symptoms become worse while resting at the same altitude. […] Supplemental oxygen and descent are the definitive therapy for all forms of altitude illness; however, descent may not always be possible due to climate, environmental, or logistic issues. […] The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen (first line), and descent to a lower altitude (first line if oxygen is unavailable). If diagnosed early, recovery is rapid with a descent of only 500-1000 m. A portable hyperbaric chamber or supplemental oxygen administration immediately increases oxygen saturation and reduces pulmonary artery pressure, heart rate, respiratory rate, and symptoms. In situations where descent is difficult, these treatments can be lifesaving.

• #80 Pulmonary edema – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/diagnosis-treatment/drc-20377014

  Inotropes. This type of medication is given through an IV for people in the hospital with severe heart failure. Inotropes improve heart pumping function and maintain blood pressure. […] Morphine (MS Contin, Infumorph, others). This narcotic may be taken by mouth or given through an IV to relieve shortness of breath and anxiety. But some care providers believe that the risks of morphine may outweigh the benefits. They’re more likely to use other drugs. […] It is important to diagnosis and treat, if possible, any nervous system problems or causes of heart failure. […] Oxygen is the usually the first treatment. If oxygen isn’t available, a portable hyperbaric chamber can imitate going down to a lower elevation until it’s possible to move to a lower elevation. […] Treatments for high-altitude pulmonary edema (HAPE) also include:

• #81 High-Altitude Pulmonary Edema (HAPE) Treatment & Management: Approach Considerations, Medical Care, Prevention

  https://emedicine.medscape.com/article/300716-treatment

  Educate travelers with the following three Centers for Disease Control and Prevention (CDC) principles to prevent death or serious consequences from altitude illness: Know the early symptoms of altitude illness, and be willing to acknowledge when they are present. Never ascend to sleep at a higher altitude when experiencing symptoms of altitude illness, no matter how minor they seem. Descend if the symptoms become worse while resting at the same altitude. […] Supplemental oxygen and descent are the definitive therapy for all forms of altitude illness; however, descent may not always be possible due to climate, environmental, or logistic issues. […] The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen (first line), and descent to a lower altitude (first line if oxygen is unavailable). If diagnosed early, recovery is rapid with a descent of only 500-1000 m. A portable hyperbaric chamber or supplemental oxygen administration immediately increases oxygen saturation and reduces pulmonary artery pressure, heart rate, respiratory rate, and symptoms. In situations where descent is difficult, these treatments can be lifesaving.

• #82 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. […] Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications. […] Immediate treatment is necessary for acute pulmonary edema to prevent death. […] To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 meters) a day once you reach 8,200 feet (about 2,500 meters). […] Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

• #83 High-Altitude Pulmonary Edema (HAPE) Treatment & Management: Approach Considerations, Medical Care, Prevention

  https://emedicine.medscape.com/article/300716-treatment

  A randomized, double-blinded, placebo-controlled study showed that adults with previous HAPE who received prophylactic tadalafil (10 mg) or dexamethasone (8 mg) had significantly less HAPE compared with those who received placebo twice daily. […] The conclusion was that both dexamethasone and tadalafil decrease systolic pulmonary artery pressure and may reduce the incidence of HAPE in adults with a history of HAPE. Dexamethasone prophylaxis may also reduce the incidence of acute mountain sickness in these adults. […] Portable hyperbaric chambers (Gamow, CERTEC) are in wide use by trekkers. A physiologic (simulated) descent of approximately 2000 m may be achieved in a few minutes. Patients are typically treated in 1-hour increments. Patients should be closely observed for rebound symptoms after hyperbaric treatments. […] Finally, the use of an expiratory positive airway pressure mask improves oxygenation and may be useful as a temporizing measure. […] Admission to a hospital is warranted for significant arterial desaturation and clinical deterioration despite outpatient management of HAPE.

• #84 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. […] Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications. […] Immediate treatment is necessary for acute pulmonary edema to prevent death. […] To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 meters) a day once you reach 8,200 feet (about 2,500 meters). […] Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

• #85

  https://journals.lww.com/acsm-csmr/fulltext/2013/03000/high_altitude_pulmonary_edema__diagnosis,.16.aspx

  However, a recent prospective, cross-sectional study demonstrated no additional benefit of nifedipine compared with placebo when used in combination with descent and supplemental oxygen. […] This further supports the fundamental principle that HAPE treatment must focus on descent and supplemental oxygen, and that nifedipine should not be considered as monotherapy, unless descent is impossible and oxygen or hyperbaric chamber is unavailable. […] Phosphodiesterase inhibitors, such as tadalafil or sildenafil, cause pulmonary vasodilation and decrease pulmonary artery pressure, providing a strong physiologic rationale for their use in the treatment of HAPE. […] Treatment options for HAPE are summarized and graded in Table 3. […] After evacuation to a lower altitude, hospitalization may be indicated for severe HAPE cases. Treatment consists of bed rest and oxygen supplementation to keep saturations greater than 90%.

• #86 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Patients who remain hypoxic despite supplemental oxygenation and patients who have severe respiratory distress require ventilatory support in addition to maximal medical therapy. […] Ultrafiltration is a fluid removal procedure that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] Intra-aortic balloon pumping (IABP) can be employed to achieve hemodynamic stabilization in the patient before definitive therapy. The IABP decreases afterload as the pump deflates; during diastole, the pump inflates to improve coronary blood flow. […] Patients admitted with heart failure or pulmonary edema should be given a low-salt diet to minimize fluid retention. Closely monitor their fluid balance. […] Consider noninvasive pressure-support ventilation (NPSV) early when treating patients with severe CPE.

• #87 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema

  Cardiogenic pulmonary edema is a life-threatening accumulation of excess fluid in your lungs because of pressure in your heart. Medications can get rid of the extra fluid, but your healthcare provider may need to do procedures as well. Treatments vary depending on the cause. The outlook for this problem depends on whats causing your edema. […] Procedures or invasive treatments for cardiac edema include: Percutaneous coronary intervention (PCI). Ventricular assist device. Heart valve replacement. Coronary artery bypass graft. Intra-aortic balloon pump (IABP), which helps your heart pump better. Extracorporeal membrane oxygenation (ECMO). Heart transplant. […] Your healthcare provider may prescribe: Vasodilators to widen your blood vessels. Diuretics to help you get more fluids out of your body.

• #88 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Patients who remain hypoxic despite supplemental oxygenation and patients who have severe respiratory distress require ventilatory support in addition to maximal medical therapy. […] Ultrafiltration is a fluid removal procedure that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] Intra-aortic balloon pumping (IABP) can be employed to achieve hemodynamic stabilization in the patient before definitive therapy. The IABP decreases afterload as the pump deflates; during diastole, the pump inflates to improve coronary blood flow. […] Patients admitted with heart failure or pulmonary edema should be given a low-salt diet to minimize fluid retention. Closely monitor their fluid balance. […] Consider noninvasive pressure-support ventilation (NPSV) early when treating patients with severe CPE.

• #89 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  ACE inhibitors are generally considered the cornerstones for treating chronic CHF, and studies have demonstrated excellent results with ACE inhibitors for the treatment of acute decompensated CHF and CPE. […] Nitroprusside results in simultaneous preload and afterload reduction by causing direct smooth-muscle relaxation, with an increased effect on afterload. […] Inotropic support is usually used when preload- and afterload-reduction strategies are not successful or when hypotension precludes the use of these strategies. […] Levosimendan is a calcium sensitizer that is used in several European countries to manage moderate to severe heart failure. […] Ultrafiltration (UF) is a method of fluid removal that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] After the patient’s condition has been stabilized, further inpatient care depends on the underlying cause of the episode of CPE. […] Transfer of patients to a tertiary receiving hospital is generally indicated if the initial hospital lacks adequate resources to care for the patient.

• #90 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Patients who remain hypoxic despite supplemental oxygenation and patients who have severe respiratory distress require ventilatory support in addition to maximal medical therapy. […] Ultrafiltration is a fluid removal procedure that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] Intra-aortic balloon pumping (IABP) can be employed to achieve hemodynamic stabilization in the patient before definitive therapy. The IABP decreases afterload as the pump deflates; during diastole, the pump inflates to improve coronary blood flow. […] Patients admitted with heart failure or pulmonary edema should be given a low-salt diet to minimize fluid retention. Closely monitor their fluid balance. […] Consider noninvasive pressure-support ventilation (NPSV) early when treating patients with severe CPE.

• #91 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema

  Cardiogenic pulmonary edema is a life-threatening accumulation of excess fluid in your lungs because of pressure in your heart. Medications can get rid of the extra fluid, but your healthcare provider may need to do procedures as well. Treatments vary depending on the cause. The outlook for this problem depends on whats causing your edema. […] Procedures or invasive treatments for cardiac edema include: Percutaneous coronary intervention (PCI). Ventricular assist device. Heart valve replacement. Coronary artery bypass graft. Intra-aortic balloon pump (IABP), which helps your heart pump better. Extracorporeal membrane oxygenation (ECMO). Heart transplant. […] Your healthcare provider may prescribe: Vasodilators to widen your blood vessels. Diuretics to help you get more fluids out of your body.

• #92 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema

  Cardiogenic pulmonary edema is a life-threatening accumulation of excess fluid in your lungs because of pressure in your heart. Medications can get rid of the extra fluid, but your healthcare provider may need to do procedures as well. Treatments vary depending on the cause. The outlook for this problem depends on whats causing your edema. […] Procedures or invasive treatments for cardiac edema include: Percutaneous coronary intervention (PCI). Ventricular assist device. Heart valve replacement. Coronary artery bypass graft. Intra-aortic balloon pump (IABP), which helps your heart pump better. Extracorporeal membrane oxygenation (ECMO). Heart transplant. […] Your healthcare provider may prescribe: Vasodilators to widen your blood vessels. Diuretics to help you get more fluids out of your body.

• #93 Cardiogenic Pulmonary Edema: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/22941-cardiogenic-pulmonary-edema

  Cardiogenic pulmonary edema is a life-threatening accumulation of excess fluid in your lungs because of pressure in your heart. Medications can get rid of the extra fluid, but your healthcare provider may need to do procedures as well. Treatments vary depending on the cause. The outlook for this problem depends on whats causing your edema. […] Procedures or invasive treatments for cardiac edema include: Percutaneous coronary intervention (PCI). Ventricular assist device. Heart valve replacement. Coronary artery bypass graft. Intra-aortic balloon pump (IABP), which helps your heart pump better. Extracorporeal membrane oxygenation (ECMO). Heart transplant. […] Your healthcare provider may prescribe: Vasodilators to widen your blood vessels. Diuretics to help you get more fluids out of your body.

• #94 Pulmonary Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema

  Specific additional treatment depends on etiology: For acute myocardial infarction or another acute coronary syndrome, thrombolysis or direct percutaneous coronary angioplasty with or without stent placement. For severe hypertension, an IV vasodilator. For supraventricular or ventricular tachycardia, direct-current cardioversion. For rapid atrial fibrillation, cardioversion is preferred. To slow the ventricular rate, an IV beta-blocker, IV digoxin, or cautious use of an IV calcium channel blocker. […] Once patients are stabilized, long-term HF treatment is begun.

• #95 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #96 Pulmonary Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema

  Specific additional treatment depends on etiology: For acute myocardial infarction or another acute coronary syndrome, thrombolysis or direct percutaneous coronary angioplasty with or without stent placement. For severe hypertension, an IV vasodilator. For supraventricular or ventricular tachycardia, direct-current cardioversion. For rapid atrial fibrillation, cardioversion is preferred. To slow the ventricular rate, an IV beta-blocker, IV digoxin, or cautious use of an IV calcium channel blocker. […] Once patients are stabilized, long-term HF treatment is begun.

• #97 Pulmonary edema (Proceedings)

  https://www.dvm360.com/view/pulmonary-edema-proceedings-0

  Treatment of animals with non-cardiogenic pulmonary edema is less straightforward than treatment of cardiogenic pulmonary edema. Animals with acute non-cardiogenic edema from electric cord injury, upper airway obstruction generally improve rapidly if allowed to rest in oxygen. Some clinicians advocate therapy diuretics, anti-inflammatories (i.e. dexamethasone) or colloids (i.e. hetastarch) although no compelling evidence exists to favor one form of therapy over another. In animals with non-cardiogenic pulmonary edema from other sources, therapy is dependent upon the underlying cause, but may include antibiotics or intravenous fluids. Dogs with severe non-cardiogenic pulmonary edema may occasionally require mechanical ventilatory support. The prognosis for non-cardiogenic edema ranges from good to grave.

• #98 Pulmonary Edema vs. Emphysema: Symptoms, Causes & Treatment

  https://www.emedicinehealth.com/pulmonary_edema_vs_emphysema/article_em.htm

  Treatment for cardiogenic pulmonary edema includes oxygen, intravenous diuretics, heart medications, and morphine for anxiety. In an emergency situation treatment for pulmonary edema may include positive airway pressure breathing machines (CPAP, BiPAP) or intubation (putting a tube into the airway) and using a ventilator. […] Treatment for acute non-cardiogenic pulmonary edema focuses on decreasing lung inflammation and the short-term use of mechanical ventilation with CPAP, BiPAP, or a ventilator may be used. The underlying cause of pulmonary edema needs to be diagnosed and treated. […] Treatment for emphysema includes quitting smoking, pulmonary rehabilitation (exercise, breathing techniques, education, and therapies), use of medications (including bronchodilators, steroids, and antibiotics), and oxygen. Surgical may be needed in patients with advanced emphysema.

• #99 Pulmonary Edema vs. Emphysema: Symptoms, Causes & Treatment

  https://www.emedicinehealth.com/pulmonary_edema_vs_emphysema/article_em.htm

  In cardiogenic pulmonary edema, efforts to maximize heart function and decrease the amount of work the heart has to do are attempted to try to decrease the amount of fluid that the heart has to pump. This should decrease the amount of fluid build-up in the lungs and relieve symptoms. In the acute situation, oxygen is the first drug that may help reduce dyspnea, or shortness of breath. […] Intravenous diuretics [furosemide (Lasix), bumetanide (Bumex)] are first-line medications to help the kidneys remove excess fluid from the body. […] In non-cardiogenic pulmonary edema, the focus will be on decreasing lung inflammation. While the above medications may be considered, the short-term use of mechanical ventilation with CPAP, BiPAP, or a ventilator may be indicated. The underlying cause of pulmonary edema needs to be diagnosed, and this will direct further therapy.

• #100 Pulmonary edema (Proceedings)

  https://www.dvm360.com/view/pulmonary-edema-proceedings-0

  Treatment of animals with non-cardiogenic pulmonary edema is less straightforward than treatment of cardiogenic pulmonary edema. Animals with acute non-cardiogenic edema from electric cord injury, upper airway obstruction generally improve rapidly if allowed to rest in oxygen. Some clinicians advocate therapy diuretics, anti-inflammatories (i.e. dexamethasone) or colloids (i.e. hetastarch) although no compelling evidence exists to favor one form of therapy over another. In animals with non-cardiogenic pulmonary edema from other sources, therapy is dependent upon the underlying cause, but may include antibiotics or intravenous fluids. Dogs with severe non-cardiogenic pulmonary edema may occasionally require mechanical ventilatory support. The prognosis for non-cardiogenic edema ranges from good to grave.

• #101 Pulmonary edema (Proceedings)

  https://www.dvm360.com/view/pulmonary-edema-proceedings-0

  Treatment of animals with non-cardiogenic pulmonary edema is less straightforward than treatment of cardiogenic pulmonary edema. Animals with acute non-cardiogenic edema from electric cord injury, upper airway obstruction generally improve rapidly if allowed to rest in oxygen. Some clinicians advocate therapy diuretics, anti-inflammatories (i.e. dexamethasone) or colloids (i.e. hetastarch) although no compelling evidence exists to favor one form of therapy over another. In animals with non-cardiogenic pulmonary edema from other sources, therapy is dependent upon the underlying cause, but may include antibiotics or intravenous fluids. Dogs with severe non-cardiogenic pulmonary edema may occasionally require mechanical ventilatory support. The prognosis for non-cardiogenic edema ranges from good to grave.

• #102 Pulmonary Edema – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pulmonary-edema/

  Ventilation is a nonpharmacologic intervention that aims to increase oxygenation, move fluids back into the capillaries, and reverse respiratory acidosis. It is typically reserved for patients with oxygen saturation (SpO2) less than 92%. […] Intensive care is required for patients with pulmonary edema who require intubation; have symptoms of hypoperfusion; have an SpO2 less than 90% while on oxygen; have a heart rate less than 40 bpm or greater than 130 bpm; and/or have a systolic blood pressure 90 mm Hg. […] Hospitalized patients with pulmonary edema should have their weight, serum electrolytes, and renal function monitored daily. Individual medications and side effects to monitor include: […] The potential for drug interactions should be considered if new medications are started in the inpatient setting to treat the underlying cause of pulmonary edema. Importantly, nitrates should not be administered to patients who have received treatment with a phosphodiesterase inhibitor, such as sildenafil, within the previous 24 hours.

• #103 Pulmonary edema (Proceedings)

  https://www.dvm360.com/view/pulmonary-edema-proceedings-0

  In all forms of pulmonary edema, monitoring should include respiratory rate and effort, heart rate, blood pressure, body temperature and oxygen saturation (pulse oximetry/arterial blood gas analysis). The veterinarian should remember to let the patient rest in a stress-free environment as much as possible. […] Patients with pulmonary edema may be challenging to manage. Early attempts should be made to distinguish cardiogenic from non-cardiogenic pulmonary edema. The prognosis is dependent upon the underlying cause.

• #104 Cardiogenic Pulmonary Edema Treatment & Management: Approach Considerations, Ventilatory Support, Preload Reduction

  https://emedicine.medscape.com/article/157452-treatment

  Patients who remain hypoxic despite supplemental oxygenation and patients who have severe respiratory distress require ventilatory support in addition to maximal medical therapy. […] Ultrafiltration is a fluid removal procedure that is particularly useful in patients with renal dysfunction and expected diuretic resistance. […] Intra-aortic balloon pumping (IABP) can be employed to achieve hemodynamic stabilization in the patient before definitive therapy. The IABP decreases afterload as the pump deflates; during diastole, the pump inflates to improve coronary blood flow. […] Patients admitted with heart failure or pulmonary edema should be given a low-salt diet to minimize fluid retention. Closely monitor their fluid balance. […] Consider noninvasive pressure-support ventilation (NPSV) early when treating patients with severe CPE.

• #105 Acute Pulmonary Edema: Emergency Care Algorithm – Should We Remove or Redistribute the Fluid? | ClinCaseQuest

  https://clincasequest.hospital/acute-pulmonary-edema/

  Inotropic agents should be initiated only when hypotension is present with reduced organ perfusion. In such cases, dobutamine is usually the first-line treatment. […] Diuretics are indicated only for patients who exhibit signs of fluid overload. Intravenous administration of furosemide in doses of 40 to 80 mg is preferred. […] Morphine was traditionally part of the treatment regimen for acute pulmonary edema due to its ability to reduce shortness of breath. However, the use of morphine carries several side effects, including respiratory and central nervous system depression, decreased cardiac output, and hypotension. […] The first step in improving ventilation for patients with acute pulmonary edema is to ensure they are in a sitting position, which helps reduce the ventilation-perfusion mismatch. […] If persistent hypercapnia, hypoxemia, or acidosis occurs despite noninvasive ventilation, intubation should be considered.

• #106 Pulmonary edema (Proceedings)

  https://www.dvm360.com/view/pulmonary-edema-proceedings-0

  In all forms of pulmonary edema, monitoring should include respiratory rate and effort, heart rate, blood pressure, body temperature and oxygen saturation (pulse oximetry/arterial blood gas analysis). The veterinarian should remember to let the patient rest in a stress-free environment as much as possible. […] Patients with pulmonary edema may be challenging to manage. Early attempts should be made to distinguish cardiogenic from non-cardiogenic pulmonary edema. The prognosis is dependent upon the underlying cause.

• #107

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12483

  Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have trouble breathing or have wheezing that is getting worse. You are coughing more deeply or more often. You cough up blood. You get a fever. You have more swelling in your legs or belly. Your symptoms are getting worse.

• #108 Pulmonary Edema: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.pulmonary-edema-care-instructions.tw12483

  Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. […] Call your doctor now or seek immediate medical care if: You have trouble breathing or have wheezing that is getting worse. You are coughing more deeply or more often. You cough up blood. You get a fever. You have more swelling in your legs or belly. Your symptoms are getting worse.

• #109

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12483

  Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have trouble breathing or have wheezing that is getting worse. You are coughing more deeply or more often. You cough up blood. You get a fever. You have more swelling in your legs or belly. Your symptoms are getting worse.

• #110 Pulmonary Edema: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.pulmonary-edema-care-instructions.tw12483

  Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. […] Call your doctor now or seek immediate medical care if: You have trouble breathing or have wheezing that is getting worse. You are coughing more deeply or more often. You cough up blood. You get a fever. You have more swelling in your legs or belly. Your symptoms are getting worse.

• #111 Pulmonary Edema: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24218-pulmonary-edema

  Pulmonary edema is a serious medical condition. If you have acute (sudden) pulmonary edema, you need to be treated right away. The outlook for pulmonary edema depends on the cause of the condition, how severe your case is and how quickly you receive treatment. With immediate treatment, your chances of recovery are higher.

• #112 Pulmonary Edema | UMass Memorial Health

  https://www.ummhealth.org/health-library/pulmonary-edema

  If treated right away, pulmonary edema can be improved and hopefully resolved. In some cases, ongoing treatment is needed to help prevent and control the problem. This may require having procedures or taking medicines for months or years. In some cases, you may need to use oxygen or breathing equipment for a long time. This can lead to complications, such as damage to lung tissue. Your provider can explain your treatment and management options.

• #113 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. […] Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications. […] Immediate treatment is necessary for acute pulmonary edema to prevent death. […] To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 meters) a day once you reach 8,200 feet (about 2,500 meters). […] Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

• #114 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #115 Managing acute pulmonary oedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5408000/

  Acute pulmonary oedema has a high mortality. It requires emergency management and usually admission to hospital. […] The goals of therapy are to improve oxygenation, maintain an adequate blood pressure for perfusion of vital organs, and reduce excess extracellular fluid. The underlying cause must be addressed. […] There is a lack of high-quality evidence to guide the treatment of acute pulmonary oedema. The strongest evidence is for nitrates and non-invasive ventilation. […] Diuretics are indicated for patients with fluid overload. Furosemide (frusemide) should be given by slow intravenous injection. […] Routine use of morphine is not recommended because of its adverse effects. Oxygen should only be administered in cases of hypoxaemia. […] Inotropic drugs should only be started when there is hypotension and evidence of reduced organ perfusion. In these cases, dobutamine is usually first-line treatment.

• #116 Managing acute pulmonary oedema – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/managing-acute-pulmonary-oedema.html

  Intravenous inotropic drugs are indicated in acute pulmonary oedema when there is hypotension and evidence of reduced organ perfusion. […] The underlying cause of the patients acute pulmonary oedema should be treated. […] Guidelines have highlighted that there is a lack of evidence to support the currently used therapies. Additionally there are concerns regarding the efficacy and safety of these treatments for acute pulmonary oedema. There has therefore been a shift over the last few years to favour nitrates and non-invasive ventilation as first-line management.

• #117

  https://journals.lww.com/acsm-csmr/fulltext/2013/03000/high_altitude_pulmonary_edema__diagnosis,.16.aspx

  The most reliable and effective treatment for HAPE is immediate descent of at least 1,000 m (approximately 3,280 ft), supplemental oxygen to achieve an arterial saturation greater than 90%, or both. […] If evacuation to a lower altitude is unsafe or impossible (e.g., severe weather) and supplemental oxygen is unavailable, a portable hyperbaric chamber (e.g., Gamow bag, Certec bag, and PAC) can be used at 2 to 4 lbinch2 for several hours to simulate a descent of 1,500 m or more (approximately 5,000 ft) as a temporizing measure until actual descent can be effected. […] If none of the given methods are feasible or available for treating a HAPE patient, adjunctive pharmacologic therapy may be considered but should not be regarded as a substitute for descent or supplemental oxygen. […] A single, nonrandomized, unblinded study in individuals with mild HAPE demonstrated that nifedipine therapy resulted in a 50% reduction in systolic pulmonary artery pressure, narrowing of the alveolar-arterial oxygen gradient, and improvement in radiographic scores as pulmonary edema cleared.

• #118 Could new gene therapy be the solution to pulmonary edema? – RegMedNet

  https://www.regmednet.com/could-new-gene-therapy-be-the-solution-to-pulmonary-edema/

  A team of researchers discovered that a new AAV-based gene therapy reduces vascular leakage and may hold potential as a pulmonary edema treatment. […] Unfortunately, there is currently no treatment available to directly treat the leakage. […] With our method, we can actually target the leak, which is a much more efficient way to address the problem. […] The team hypothesized that a gene therapy delivering a specific region of CD98hc could be an effective treatment for vascular leakage that leads to pulmonary edema. […] Remarkably, we saw a significant improvement in lung function even though only about 30% of the lung epithelial cells and 10% of the vascular endothelial cells were successfully transduced with the gene coding for the HH domain of CD98, indicating that this strategy is extremely protective, commented co-author Rachelle Prantil-Baun (Wyss Institute for Biologically Inspired Engineering). […] Going forward, the authors hope that the findings from this study can lead to the development of specific mechanotherapeutic drugs for more targeted treatment of pulmonary edema.

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