High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema

Sharon, Ahuva; Shpirer, Isaac; Kaluski, Edo; Moshkovitz, Yaron; Milovanov, Olga; Polak, Roman; Blatt, Alex; Simovitz, Avi; Shaham, Ori; Faigenberg, Zvi; Metzger, Michael; Stav, David; Yogev, Robert; Golik, Ahuva; Krakover, Ricardo; Vered, Zvi; Cotter, Gad

doi:10.1016/s0735-1097(00)00785-3

Cited by 197 publications

(144 citation statements)

References 10 publications

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“…In the first one 202 , NIV was compared with the use of high doses of nitrates. The study was interrupted early because of the excessive number of adverse events and reduced efficacy in the NIV arm.…”

Section: F Acute Pulmonary Edema (Table 26)mentioning

confidence: 99%

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Bocchi¹,

Vilas-Boas²,

Perrone³

et al. 2005

Arq. Bras. Cardiol.

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Section: F Acute Pulmonary Edema (Table 26)mentioning

confidence: 99%

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Bocchi¹,

Vilas-Boas²,

Perrone³

et al. 2005

Arq. Bras. Cardiol.

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“…In another nitrate trial, 40 patients were randomized to receive 4 mg ISDN every 4 min or bi-level positive airway pressure (BiPAP) plus a standard-dose ISDN infusion starting at 10 μmol/min and increased every 5-10 min, which is considered a conventional treatment. The researchers found a lower mortality rate (0% compared with 40%) in the 4 mg ISDN group, less need for mechanical ventilation (20% compared with 80%), and a lower incidence of MI (10% compared with 55%) (19). Recently, Breidthardt showed that sublingual and transdermal nitrates had an improving effect on the mortality in patients with acute HF.…”

Section: Discussionmentioning

confidence: 99%

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Topuz¹,

Kaplan²

2018

Eur J Ther

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Objective: The aim of this study was to evaluate the potential of intravenous (IV) nitroglycerine (NTG) administration to accelerate the reduction of B-type natriuretic peptide (BNP) levels in patients with decompensated systolic heart failure (HF) and to evaluate its impact on follow-up events. Methods: A total of 165 patients with systolic HF who were hospitalized due to acute decompensation were enrolled into the current study. Study patients were divided into two groups. Patients who were receiving standard HF therapy (angiotensin-converting enzyme [ACE] or angiotensin receptor blocker [ARB], beta-blockers, loop diuretics, and anticoagulant or anti-aggregant agents for venous prophylaxis) were categorized as the standard HF therapy group (n=72), and patients receiving a standard dose of IV NTG in addition to standard HF therapy were categorized as the IV NTG group (n=93). BNP levels and blood gas analyses were measured at admission and after 48 h; all patients were followed up along the first month after discharge. Results: Serum BNP levels decreased in all patients after 48 h. The decreasing of BNP level was higher and the improvement of blood gas analysis was better in the IV NTG group than in the standard therapy group (1347.1±314.3 vs. 280.0±196.2 pg/mL for the IV NTG group and 1178.3±305.5 vs. 495.4±229.9 pg/mL for the standard therapy group; p<0.001). In the multi-logistic regression analysis, serum sodium at admission, BNP level at 48 h, and use of IV NTG were found as predictors of 30-day follow-up events. Conclusion:We have shown that IV NTG therapy in addition to standard HF therapy has a markedly better effect on lowering of plasma BNP levels, improves blood gas analyses, and may reduce follow-up events in patients with systolic HF.

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“…In a randomized controlled trial of 110 patients comparing high‐ versus low‐dose nitrates, Cotter et al reported that there was no difference in mortality rates, although there were only 4 deaths in total during the study 24. Sharon and colleagues randomized 40 patients with severe pulmonary edema to either intravenous nitrates or noninvasive positive pressure ventilation and demonstrated a reduction in the composite end point of death, myocardial infarction, or mechanical ventilation in the intravenous nitrate group 13. However, the study was terminated prematurely and a total of 2 deaths occurred during the study, limiting its inference in relation to survival benefit.…”

Section: Discussionmentioning

confidence: 99%

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

Parker

Austin

et al. 2016

JAHA

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BackgroundThere is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study.Methods and ResultsWe examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity‐matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity‐matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non‐nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow‐up. There was no significant difference in survival or hospital length of stay between nitrate and non‐nitrate controls in extended follow‐up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease.ConclusionsIn acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short‐term or near‐term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality.

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High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema

Abstract: High dose ISDN is safer and better than BiPAP ventilation combined with conventional therapy in patients with severe pulmonary edema.

Cited by 197 publications

References 10 publications

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

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