Pulmonary edema medical therapy

Treatment
See also the chapter on congestive heart failure.

Acute Pulmonary Edema
In patients with acute pulmonary edema, the goal is to reduce both preload and afterload and to diurese the patient. Intravenous nitroglycerin can be used to reduce both the preload and afterload. Diuretics such as furosemide or bumetanide can be used to reduce volume overload. The dose that the patient is on chronically should be doubled and administered intravenously in the setting of flash pulmonary edema. Morphine sulfate may be helpful in reducing the drive to breathe, improving patient comfort, and reducing the preload.

Oxygen therapy is required to minimize cyanosis and to maintain adequate oxygenation. High-flow oxygen, noninvasive ventilation (either continuous positive airway pressure (CPAP) or variable positive airway pressure (VPAP) may be effective ). If the simple measures are not effective then mechanical ventilation may be required.

Treatment should also be directed at managing the underlying cause of an episode of acute pulmonary edema. This would include managing as acute myocardial infarction, mitral regurgitation, aortic regurgitation, or any other condition that causes an increase in left ventricular filling pressures.

Chronic Pulmonary Edema
Reoccurrence of FPE is thought to be associated with hypertension and may signify renal artery stenosis. Prevention of reoccurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.