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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, January 1, 2017

IV Nitroglycerin Bolus for APE

The PharmERToxGuy - December 27, 2016
"Nitroglycerin (NTG) is an important preload reducer in acute pulmonary edema, and even modestly reduces afterload with high doses. For pulmonary edema in the ED, NTG is often administered as a sublingual tablet and/or IV infusion. Starting the infusion at ≥ 80 mcg/min produces rapid effects in many patients, and can be titrated higher as needed. Combined with noninvasive positive pressure ventilation (and sometimes IV enalapril), patients often turn around quickly, from the precipice of intubation to comfortably lying in bed. But what about high-dose IV bolus NTG?
In a recent UMEM pearl, Dr. Rory Spiegel highlighted two studies in which patients who received high doses of IV nitrates every 5 minute were intubated less often than patients who received a standard infusion.
A new retrospective study by Wilson and colleagues evaluated the incidence of ICU admission and hospital LOS in acute pulmonary edema patients who received intermittent high-dose NTG bolus vs. standard NTG infusion vs. bolus + infusion. This was actually a follow-up to their previously published study."