Management of acute pulmonary edema in the emergency department

Intravenous furosemide vs nebulized furosemide in patients with pulmonary edema: A randomized controlled trial

BACKGROUND AND AIMS

Pulmonary edema is one of the most common acute respiratory disorders that diagnosis and treatment of the disease still remain as a health problem. The aim of this study was to compare the efficacy of intravenous furosemide and nebulized furosemide in control of the symptoms of the patients with pulmonary edem.

METHODS

In this clinical trial, 80 patients were enrolled with pulmonary edema. Patients were randomly divided into two groups. In the intervention group the patients received nebulized furosemide at a dose of 1 mg furosemide for 20 minutes in 2 mL of sodium chloride 0.9% and in the control group the patients received intravenous furosemide at a dose of 1 mg/kg. Then, hemodynamic parameters and estimation of the clinical severity of the pulmonary edema in both groups was performed for 2 hours.

RESULTS

According to our results, we can say that nebulized furosemide is not superior to intravenous furosemide in reducing dyspnea and crackles in patients with acute pulmonary edema, but significantly improved respiratory rate and arterial blood oxygen and has less hemodynamic changes than the intravenous furosemide.

CONCLUSIONS

The results of this study showed the beneficial effects of nebulized furosemide in the treatment of pulmonary edema, which can be prescribed as a treatment in addition to standard treatment and significantly lead in better control of pulmonary edema in the short term.

Congestive Heart Failure

Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy.