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Cardiogenic pulmonary edema

mechanisms and treatment - an intensivist's view

Ingbar, David H.

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 371–378
doi: 10.1097/MCC.0000000000000626
CARDIOGENIC SHOCK: Edited by Holger Thiele
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Purpose of review This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment.

Recent findings The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with echocardiography and other testing.

Summary Treatments must be initiated early, whereas evaluation still is occurring and requires multimodality intervention. The general treatment of cardiogenic pulmonary edema includes diuretics, possibly morphine and often nitrates. The appropriate use of newer approaches – such as, nesiritide, high-dose vasodilators, milrinone, and vasopressin receptor antagonists – needs larger clinical trials.

Pulmonary, Allergy, Critical Care & Sleep Division, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Correspondence to David H. Ingbar, MD, Professor, Medicine, Pediatrics and Integrative Biology & Physiology, Director, Pulmonary, Allergy, Critical Care & Sleep Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA. Tel: +1 612 624 0999; e-mail: ingba001@umn.edu

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