A significant, sudden rise in blood pressure that causes abrupt heart failure and fluid buildup in the lungs is known as sympathetic crashing acute pulmonary edema (SCAPE). Without immediate diagnosis and care, the disease frequently quickly worsens to the point of respiratory collapse, requiring intubation and intensive care unit (ICU) admission. High-dose nitroglycerin (HDN) has replaced non-invasive positive pressure ventilation (NIPPV) as a cornerstone of therapy; nevertheless, an ideal dosage regimen has not been identified. For a study, researchers set out to investigate the characteristics and prognosis of patients who underwent an HDN infusion (≥100 μg/min) for the treatment of SCAPE in the Emergency Department (ED) of a sizable metropolitan academic medical facility. Outcomes were also examined to identify factors that predict safety and efficacy, including the use of adjunct drug therapy.

From January 1 to December 31, 2018, 67 adult patients underwent SCAPE and got HDN infusion. When HDN infusion was started, the median (IQR) systolic blood pressure (SBP) was 211 (192-233) mmHg. Patients were 84% Black, 51% had a history of heart failure (HF), 36% had an end-stage renal disease (ESRD), and 63% of them were men. With a median (IQR) peak rate of 200 (127.5-200) mcg/min in the first hour and an overall absolute maximum observed rate of 400 μg/min, IV nitroglycerin (NTG) was started at a median (IQR) dosage of 100 (100-200) mcg/min. Prior to receiving HDN infusion, 73% of patients used NIPPV, 48% got sublingual (SL) or IV bolus nitroglycerin, 58% used loop diuretics, and 34% used an ACE inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB). Acute kidney damage (AKI) at 48 hours, intubation, hypotension, and each of these events occurred at rates of 37%, 21%, 13%, and 4%, respectively.

The utilization of an HDN infusion method for the management of SCAPE was described in the research, which was the biggest to date. A secure alternative to intermittent bolus HDN may be HDN infusion.

Reference: sciencedirect.com/science/article/pii/S0735675722006532