February 7, 1998. The standard treatment of acute pulmonary edema includes the administration of morphine, oxygen, diuretics and nitrates. Diuretics such as furosemide are thought to acutely lower preload by a veno-dilatory effect, followed later by diuresis.
Diuretics can cause a reflex increase in heart rate, however, which can aggravate cardiac ischemia.
This study was designed to compare the effects of high dose nitrates and low dose furosemide with low dose nitrates and high dose furosemide in pulmonary edema. Methods Patients Patients were recruited from the emergency medical services of three cities in Israel. Heart rate, BP, respiratory rate and O 2 saturation were determined at baseline and every three minutes during treatment. Patients randomised to the high dose nitrates group received 3 mg of isosorbide dinitrate intravenously every 3 minutes. Patients randomised to the high dose furosemide group received 80 mg of furosemide iv every 15 minutes.