The following is a summary of “Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema,” published in the March 2023 issue of Emergency Medicine by Kelly, et al.

Nitroglycerin (NTG) is often used to manage pulmonary edema in acute heart failure cases. Although it’s typically started at lower infusion rates, higher infusion rates might have positive pharmacodynamic properties and potentially improve acute pulmonary edema management outcomes. For a study, researchers sought to analyze the clinical outcomes, including time to resolution of severe hypertension, when using a low-dose (<100 μg/min) initial strategy versus a high-dose (≥100 μg/min) initial strategy.

The study was performed retrospectively at a single, tertiary academic emergency department in Atlanta, GA. They looked at blood pressure effects and safety outcomes, such as intubation, hypotension, and intensive care unit admissions, during the first hour of acute pulmonary edema treatment.

The final sample consisted of 41 patients, 27 (66%) receiving low-dose NTG and 14 (34%) receiving high-dose NTG. On average, the high-dose group reached their blood pressure targets faster (hazard ratio = 3.5, 95% CI: 1.2–10.1). In the high-dose group, 8 out of 14 (57%) patients achieved their BP targets within the first hour of treatment, compared to 6 out of 27 (22%) in the low-dose group. The observed incidence of safety outcomes was similar in both groups.

In conclusion, higher initial doses of NTG might effectively decrease the time to achieve blood pressure targets in acute pulmonary edema patients. Future trials should focus on this approach.

Reference: sciencedirect.com/science/article/pii/S0735675722007677