High-Dose Nitroglycerin in Managing Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Comprehensive Review of...

This review evaluated recent clinical evidence on the management of sympathetic crashing acute pulmonary edema (SCAPE) with high-dose nitroglycerin (HDN) therapy. Several recent studies, including randomized controlled trials and cohort studies, were analyzed to assess the efficacy and safety of HDN compared with low-dose nitroglycerin (LDN). Across studies, HDN was associated with improved clinical outcomes, including reduced rates of ICU admission, intubation, and acute kidney injury; shorter hospital stays; a lower incidence of major adverse cardiac events; and more rapid achievement of blood pressure targets. Symptom resolution within six hours was consistently reported, and most patients were discharged without complications. Adverse effects, such as hypotension, were infrequent. Collectively, these findings support the use of HDN as a safe and effective intervention for SCAPE, warranting further large-scale randomized trials to confirm these promising results.