MANAGEMENT OF ACUTE PULMONARY EDEMA



The general management of acute cardiogenic pulmonary edema is summarized in Table 3-7. Furosemide and morphine comprise standard first-line drug therapy. Digitalis is not necessary acutely unless atrial fibrillation or other supra­ventricular tachyarrhythmia is contributing to the pulmonary edema. Reversible causes or exacer­bating factors of pulmonary edema should be sought (e.g., anemia, arrhythmia, etc.).
If initial measures fail to correct pulmonary edema, or if drug administration is limited by the development of hypotension, more aggressive management to include invasive hemodynamic monitoring is usually indicated. Parenteral ino­tropic and vasodilating agents may be adminis­tered. If adequate ventilation cannot be main­tained, intubation with mechanical ventilation may be required to maintain oxygenation and de­crease the work of breathing. In cases refractory to the above measures in whom a reversible process is present, intra-aortic balloon counterpul­sation may be employed.





MANAGEMENT OF ACUTE PULMONARY EDEMA