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European Journal of Heart Failure Oct 2022Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema (ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE.
METHODS AND RESULTS
A randomized, multicentre, open-label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in-hospital all-cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30-day mortality and SAE. Analyses were made on an intention-to-treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in-hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratio[RR] 0.71, 95% confidence interval [CI] 0.29-1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22-0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30-0.92; p = 0.03).
CONCLUSION
Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.
Topics: Humans; Adolescent; Midazolam; Morphine; Pulmonary Edema; Heart Failure; Hospital Mortality
PubMed: 35780488
DOI: 10.1002/ejhf.2602 -
Pediatric Critical Care Medicine : a... Aug 2016The purpose of this chapter is to outline the causes, physiology, pathophysiology, and management strategies for hydrostatic and permeability pulmonary edema and hypoxic... (Review)
Review
OBJECTIVES
The purpose of this chapter is to outline the causes, physiology, pathophysiology, and management strategies for hydrostatic and permeability pulmonary edema and hypoxic respiratory failure.
DATA SOURCE
MEDLINE and PubMed.
CONCLUSION
The pulmonary parenchyma and vasculature are at high risk in conditions where injury occurs to the lung and or heart. A targeted approach that uses strategies that optimize the particular pathophysiology of the parenchyma and vasculature is required.
Topics: Humans; Lung; Pulmonary Edema; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 27490597
DOI: 10.1097/PCC.0000000000000823 -
JACC. Cardiovascular Imaging Nov 2023Quantification of pulmonary edema and congestion is important to guide diagnosis and risk stratification, and to objectively evaluate new therapies in heart failure.... (Review)
Review
Quantification of pulmonary edema and congestion is important to guide diagnosis and risk stratification, and to objectively evaluate new therapies in heart failure. Herein, we review the validation, diagnostic performance, and clinical utility of noninvasive imaging modalities in this setting, including chest x-ray, lung ultrasound (LUS), computed tomography (CT), nuclear medicine imaging methods (positron emission tomography [PET], single photon emission CT), and magnetic resonance imaging (MRI). LUS is a clinically useful bedside modality, and fully quantitative methods (CT, MRI, PET) are likely to be important contributors to a more accurate and precise evaluation of new heart failure therapies and for clinical use in conjunction with cardiac imaging. There are only a limited number of studies evaluating pulmonary congestion during stress. Taken together, noninvasive imaging of pulmonary congestion provides utility for both clinical and research assessment, and continued refinement of methodologic accuracy, validation, and workflow has the potential to increase broader clinical adoption.
Topics: Humans; Pulmonary Edema; Predictive Value of Tests; Lung; Ultrasonography; Heart Failure
PubMed: 37632500
DOI: 10.1016/j.jcmg.2023.06.023 -
Nursing Standard (Royal College of... Feb 2016Acute pulmonary oedema is a distressing and life-threatening illness that is associated with a sudden onset of symptoms. For the best possible patient outcomes, it is...
Acute pulmonary oedema is a distressing and life-threatening illness that is associated with a sudden onset of symptoms. For the best possible patient outcomes, it is essential that nurses in all clinical areas are equipped to accurately recognise, assess and manage patients with acute pulmonary oedema. This article outlines the pathophysiology of acute cardiogenic and non-cardiogenic pulmonary oedema, and suggests a systematic approach to the recognition and management of its most serious manifestations. Long-term care and symptom recognition are discussed and suggestions for ongoing patient self-management are provided.
Topics: Education, Nursing, Continuing; Humans; Nursing Assessment; Pulmonary Edema; United Kingdom
PubMed: 26838657
DOI: 10.7748/ns.30.23.51.s47 -
Saudi Medical Journal Jun 2018Post-adenotonsillectomy pulmonary edema (pATPE) is a life-threatening condition that necessitates immediate clinical intervention. The early diagnosis and detection of... (Review)
Review
Post-adenotonsillectomy pulmonary edema (pATPE) is a life-threatening condition that necessitates immediate clinical intervention. The early diagnosis and detection of the signs of this condition is vital to its treatment and patient outcome. The purpose of this review article is to present epidemiological data on the prevalence of pATPE, and address the mechanisms of development, types, etiology, pathophysiology, and management of pATPE. In order to minimize postoperative intensive care unit admission rates of pATPE, utilization of preoperative clinical assessment, operative/postoperative monitoring tools, and procedural precautions are discussed.
Topics: Adenoidectomy; Child; Humans; Perioperative Care; Postoperative Complications; Prevalence; Pulmonary Edema; Risk Factors; Tonsillectomy
PubMed: 29915848
DOI: 10.15537/smj.2018.6.21887 -
The Journal of the American Osteopathic... Jan 2020
Topics: Adult; Chest Tubes; Female; Humans; Pneumothorax; Postoperative Complications; Pulmonary Edema; Thoracostomy
PubMed: 31904775
DOI: 10.7556/jaoa.2020.011 -
Revue Medicale Suisse Jul 2017Immersion pulmonary edema may occur during scuba diving, snorke-ling or swimming. It is a rare and often recurrent disease, mainly affecting individuals aged over 50...
Immersion pulmonary edema may occur during scuba diving, snorke-ling or swimming. It is a rare and often recurrent disease, mainly affecting individuals aged over 50 with high blood pressure. However it also occurs in young individuals with a healthy heart. The main symptoms are dyspnea, cough and hemoptysis. The outcome is often favorable under oxygen treatment but deaths are reported. A cardiac and pulmonary assessment is necessary to evaluate the risk of recurrence and possible contraindications to immersion.
Topics: Diving; Humans; Pulmonary Edema
PubMed: 28699708
DOI: No ID Found -
Intensive Care Medicine Apr 2022
Topics: Acute Disease; Continuous Positive Airway Pressure; Humans; Intensive Care Units; Pulmonary Edema
PubMed: 35178595
DOI: 10.1007/s00134-022-06639-8 -
European Neurology 2019Neurogenic pulmonary edema (NPE) is characterized by acute respiratory distress triggered by acute, severe compromise of the central nervous system (CNS). This review... (Review)
Review
BACKGROUND
Neurogenic pulmonary edema (NPE) is characterized by acute respiratory distress triggered by acute, severe compromise of the central nervous system (CNS). This review aims at summarizing and discussing recent and previous findings about the type and frequency of CNS triggers of NPE, pathogenesis, diagnosis, treatment, and outcome of patients experiencing NPE. Key Messages: NPE is diagnosed in the presence of pink, frothy sputum, pulmonary edema, bilateral opacities on X-ray, PaO2:PiO2 <200 mm Hg, acute CNS compromise with increased intra-cranial pressure, rapid resolution within 48-72 h, and the absence of alternative causes of respiratory distress. The most common cerebral triggers of NPE include enterovirus-71-associated brainstem encephalitis, subarachnoid bleeding, intracerebral bleeding, traumatic brain injury, epilepsy, ischemic stroke, intracranial/spinal surgery, multiple sclerosis, electroconvulsive therapy, subdural/epidural hematoma, intoxication, hypoxia, and hydrocephalus. Simultaneous treatment of CNS and pulmonary compromise is required. Cerebral treatment involves infectiologists, neurologists, and neurosurgeons. Pulmonary treatment is mainly supportive, but if ineffective, extracorporeal membrane oxygenation or thermodilution are alternative options. Applying intensive care measures, the outcome of NPE has improved.
SUMMARY
CNS-disease triggering NPE is more variegated than anticipated. Delineation of NPE from other pulmonary or cardiac conditions mimicking NPE is crucial to take appropriate measures and improve the outcome of these patients.
Topics: Adult; Central Nervous System Diseases; Female; Humans; Pulmonary Edema
PubMed: 31117074
DOI: 10.1159/000500139 -
Ugeskrift For Laeger Oct 2020Acute heart failure is a common and severe condition in Danish emergency hospitals. Hypertensive pulmonary oedema, cardiogenic shock and congestive heart failure are the... (Review)
Review
Acute heart failure is a common and severe condition in Danish emergency hospitals. Hypertensive pulmonary oedema, cardiogenic shock and congestive heart failure are the most common phenotypes. The aim of this review is to summarise the most recent international guidelines for acute triage and treatment of acute heart failure. Afterload is reduced with nitrates, congestion is treated with intravenous loop-diuretics, and in selected patients, cardiac output could be increased by inotropic drugs or mechanical support devices.
Topics: Acute Disease; Heart Failure; Humans; Hypertension; Pulmonary Edema; Shock, Cardiogenic; Vasodilator Agents
PubMed: 33046187
DOI: No ID Found