Acute Pulmonary Edema

Patients with acute cardiogenic pulmonary edema require rapid assessment and therapy to prevent progression to respiratory failure and cardiovascular collapse. The goal of therapy is to decrease the pulmonary capillary wedge pressure by decreasing intravascular volume and shifting the blood volume into peripheral vascular beds. Mainstays of therapy include morphine sulfate (a venodilator and an anxiolytic), furosemide (a venodilator and diuretic), nitroglycerin preparations (venodilators), and, in some cases, aminophylline, nitroprusside, and beta-adrenergic agents or milrinone. Patients who do not respond to more conservative measures may require interventional procedures, including Swan-Ganz catheterization or arterial pressure monitoring, continuous positive airway pressure or mechanical ventilation, intra- aortic balloon counterpulsation, and mechanical removal of fluid. Because the prognosis for patients with acute cardiogenic pulmonary edema depends on identification and correction of the underlying disease process, it is essential to define the cause of the edema during and after stabilization of the patient. Evaluation should include Doppler echocardiography, cardiac catheterization, and coronary angiography.