From the Guidelines
Pulmonary congestion should be treated with diuretics, such as furosemide (20-80mg daily) or bumetanide (0.5-2mg daily), as first-line medications to reduce fluid overload, and oxygen therapy should be administered to maintain oxygen saturation above 92% 1.
Treatment Overview
The primary goal of treatment is to address the underlying cause of pulmonary congestion while providing symptomatic relief. This can be achieved through a combination of pharmacological and non-pharmacological interventions.
Pharmacological Interventions
- Diuretics: Furosemide (20-80mg daily) or bumetanide (0.5-2mg daily) are commonly used to reduce fluid overload 1.
- ACE inhibitors: Lisinopril (5-40mg daily) or ARBs like losartan (25-100mg daily) may be prescribed to improve cardiac function in patients with heart failure 1.
- Vasodilators: Nitroglycerin may be necessary for acute severe congestion 1.
Non-Pharmacological Interventions
- Oxygen therapy: Should be administered to maintain oxygen saturation above 92% 1.
- Lifestyle modifications: Sodium restriction (less than 2g daily), fluid restriction (1.5-2L daily), and daily weight monitoring are essential components of management 1.
- Non-invasive positive pressure ventilation (continuous positive airway pressure, biphasic positive airway pressure) or high-flow nasal cannula may be effective in treating pulmonary oedema and should be considered in patients with respiratory distress 1.
Key Considerations
- Identifying and correcting any reversible cause of pulmonary congestion, such as hypovolaemia, drug-induced hypotension, or arrhythmias, is crucial 1.
- Ultrafiltration to reduce fluid overload may be considered in patients who are refractory to diuretics, especially in patients with hyponatraemia 1.
- Treatment with dobutamine or levosimendan may be considered in patients with heart failure and adequate blood pressure, but a severe reduction in cardiac output resulting in compromised vital organ perfusion not responding to standard therapy 1.
From the Research
Pulmonary Congestion Treatment
- Pulmonary congestion can be treated with various medications, including diuretics, vasodilators, and inotropes 2.
- The use of nitroglycerin has been shown to be beneficial in the management of presumed pre-hospital pulmonary edema, while morphine and furosemide may not add anything to its efficacy and may be potentially deleterious in some patients 3.
- Furosemide, a diuretic, can be used to treat pulmonary congestion, but its use may be associated with clinically important problems with fluid and electrolyte management 3.
Furosemide Use in COPD
- Nebulizing furosemide has been shown to improve and normalize vital signs and other respiratory variables in patients with chronic obstructive pulmonary disease (COPD) 4.
- Inhaled furosemide may be effective in improving feelings of dyspnea and pulmonary function values in patients with COPD, but the long-term impact of this therapy remains uncertain 5.
- The use of systemic medications, including furosemide, in COPD patients may be beneficial in certain situations, but further research is needed to identify the optimal target populations and determine how these treatments should be positioned in the global treatment algorithm 6.
Acute Heart Failure Syndromes
- Pulmonary congestion is a common symptom of acute heart failure syndromes (AHFS), and vasodilators may be useful in patients with signs and symptoms of pulmonary congestion who have not responded to diuretics 2.
- The early initiation of vasoactive medications, including diuretics and vasodilators, has been linked to improved outcomes in some reports, while the use of inotropes is de-emphasized 2.