R.E.B.E.L.EM - 08 June 2015
"Background:
Intravenous morphine use has been reported in nearly one of seven patients hospitalized with acute decompensated heart failure (ADHF). I have anecdotally, even seen physicians giving morphine as a “first-line” agent: Nitroglycerine, Non-Invasive Positive Pressure Ventilation (NIPPV), and Morphine. There is surprisingly little evidence supporting routine use of morphine in ADHF, and no major American cardiology or emergency medicine society has really endorsed or published any recommendations on the treatment of ADHF with morphine.
What Study are we Discussing?
Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209. PMID: 18356349
Author Conclusion:
In this preliminary registry analysis of ADHF, the use of morphine was associated with a longer stay in the hospital, more frequent and longer ICU admissions, and a greater risk of in-hospital mortality.
Clinical Take Home Point:
The use of IV morphine in ADHF is associated with increased morbidity and mortality and should be abandoned completely as a “first-line” medical therapy. If you want to decrease diastolic filling pressures in ADHF from venous pooling just use nitroglycerin."
http://rebelem.com/morphine-kills-in-acute-decompensated-heart-failure/