Managing Patients With Sympathetic Crashing Acute Pulmonary Edema (SCAPE) Using the SCAPE Treatment Protocol: A Case...

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Cardiology

Background:

• Pulmonary edema, characterized by alveolar fluid accumulation, presents a significant mortality risk.
• Prompt assessment and management are crucial for patients with acute pulmonary edema.
• Intravenous nitroglycerin is a potential therapeutic agent for severe pulmonary edema.

Purpose of the Study:

• To evaluate the efficacy of a specific treatment protocol for sympathetic crashing acute pulmonary edema (SCAPE).
• To assess the use of high-dose intravenous nitroglycerin combined with bilevel positive airway pressure in SCAPE management.
• To determine the impact of this protocol on patient outcomes, including blood pressure control and need for intubation.

Main Methods:

• A case series involving 3 patients presenting with SCAPE to the emergency department.
• Management involved high-dose intravenous nitroglycerin administration.
• Bilevel positive airway pressure support was utilized as part of the SCAPE treatment protocol.

Main Results:

• The SCAPE treatment protocol led to early correction of elevated blood pressure in all patients.
• Endotracheal intubation was successfully avoided in all cases.
• No episodes of hypotension or rebound hypertension were observed post-treatment.

Conclusions:

• The SCAPE treatment protocol, incorporating high-dose intravenous nitroglycerin and bilevel positive airway pressure, is effective for managing SCAPE.
• Emergency physicians should consider utilizing this protocol for patients presenting with SCAPE.
• This approach facilitates rapid hemodynamic stabilization and prevents invasive ventilation.