Abstract
Objective: Acute pulmonary edema (APE) is a common problem presenting in emergency department of cardiology units. For decades, the mainstay of treatment in APE has been loop diuretics; mainly furosemide. Studies regarding mortality benefits of diuretics in APE patient have not been conducted in our population, where other drugs of heart failure are not frequently available. Therefore, results of our study may provide justification for continued use of diuretics as mainstay treatment of APE. Aim of this prospective study was undertaken to determine the relationship between dose of furosemide and mortality. Methodology: This prospective study was conducted at department of cardiology, SMBBMU, Larkana from June 2017 to December 2017. Patients of either gender, aged between 18 to 75 years presenting with diagnosis of APE were included in the study. Patients were followed up till time of discharge or death. Outcome variable i-e mortality was noted and recorded. Results: A total of 402 patients were included in this study out of which 234 (58.2%) were males. In-hospital mortality was 17.9% (77). Total amount of diuretics used was significantly lesser among the patients who died (209.28 ± 134.15 ml vs. 295.18 ± 151.43 ml; p-value <0.001). Patients who received less than 300mg/day diuretics had increased mortality as compared to those who received more than 300 mg/day (59 (20.3%) vs. 13 (11.7%); p-valve 0.045). Conclusion: Patients who received less diuretic had more mortality than those who received more diuretic.
Highlights
Treatment strategy of acute pulmonary edema (APE) is directed at reducing preload, afterload and increasing functional reserve of the heart
A total of 402 patients were included in this study out of which 234 (58.2%) were males
Total amount of diuretics used was significantly lesser among the patients who died (209.28 ± 134.15 ml vs. 295.18 ± 151.43 ml; p-value
Summary
Treatment strategy of acute pulmonary edema (APE) is directed at reducing preload, afterload and increasing functional reserve of the heart. Agents which decrease preload and afterload have been used in management of APE for decades. Diuretic still remains mainstay of treatment in majority of centers in Pakistan. It has remained a matter of controversy whether diuretics have any role in APE. Studies have suggested that majority of patients with APE are not volume overloaded.[1,2] some patients are dehydrated. Problem is not volume overload but shifting of volume from other compartments and accumulation in lungs is the cause of APE.[3]
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