[Shall we Follow the Guidelines for Isosorbide Dinitrate in Acute Pulmonary Edema?]

Prospective evaluation of short (dyspnoea) and mid-term outcomes in 47 consecutive patients admitted in the intensive care unit for acute pulmonary edema treated on a liberal basis.

Patients were elderly (83 year-old) and 60% had preserved left ventricular ejection fraction (>50%). Dyspnoea assessed by visual analogue score was weakly associated with treatment posology. Despite low use of inotropes (6%) and intubation (9%), hospital and D90 mortality was high (19% and 32% respectively). Higher mortality was noticed in patients receiving no isosorbide dinitrate (p = 0.04). In the multivariate analysis, only age and delta brain natriuretic peptide (difference between BNP on D1 and D0) remained significantly associated with mortality on D90 (OR 1.13; p = 0.03 and OR 1.004; p = 0.04 respectively).

Acute pulmonary edema carried a dramatic in-hospital and mid-term mortality in our elderly patients. Isosorbide dinitrate was associated with decreased D90 mortality but not in the multivariate analysis.