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Original Article
Multi-centre retrospective observational study: Length of stay, mortality and intubation ratio of patients diagnosed with hypertensive cardiogenic pulmonary edema managed with high dose furosemide vs high dose nitroglycerin for the first two hours
1 PGY-III, Internal Medicine Department, San Juan City Hospital, San Juan, Puerto Rico
2 PGY-I, Internal Medicine Department, San Juan City Hospital, San Juan, Puerto Rico
3 PGY-II, Internal Medicine Department, San Juan City Hospital, San Juan, Puerto Rico
4 Fellow-IV, Pneumology and Critical Care Department, San Juan City Hospital, San Juan, Puerto Rico
5 Fellow PGY IV, Endocrinology Research Fellow, San Juan City Hospital, San Juan, Puerto Rico
6 Fellow PGY V, Cardiology Department, Hospital Episcopal San Lucas, Ponce, Puerto Rico
7 Junior Attending, Internal Medicine Department, San Juan City Hospital, San Juan, Puerto Rico
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Fermín López-Rivera
550 Calle Jazmin Coto Laurel, 00780,
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Article ID: 100010C03FR2019
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How to cite this article
Rivera FL, Colón HC, LaTorre CC, González AR, Meléndez OM, Ferrer VF, Dardiz NC, Vargas EV, Monroig HG. Multi-centre retrospective observational study: Length of stay, mortality and intubation ratio of patients diagnosed with hypertensive cardiogenic pulmonary edema managed with high dose furosemide vs high dose nitroglycerin for the first two hours. Edorium J Cardiol 2019;5:100010C03FR2019.ABSTRACT
Aims: The purpose of this study is to evaluate the length of stay of patients admitted with diagnosis of hypertensive cardiogenic pulmonary edema (HCPE) when managed with furosemide vs high nitroglycerin as monotherapy. Other outcomes such as: mortality during admission and orotracheal intubation will be evaluated as well.
Methods: Retrospective observational multicenter study composed of 137 patients, performed reviewing medical records from January-2016 to January-2018 at San Juan Hospital and Aibonito’s Hospital. We analyzed data from patients admitted with diagnosis of HCPE, classified in two groups: nitroglycerin and furosemide. Our primary outcome was to evaluate the length of stay.
Results: The nitroglycerin group reported a length of stay of 4.89 days, orotracheal intubation rate of 6% and a mortality rate of 3%. The high dose furosemide was remarkable for a length of stay of 9.88 days, orotracheal intubation 18% and mortality rate of 9%.
Conclusion: Physicians are accustomed to managing this disease with high dose diuretics, which is pharmacologically and physiologically counterproductive, despite of several studies demonstrating the benefit of high dose nitroglycerin. Medical literature should emphasize in the newer management of HCPE.
Keywords: Furosemide, Heart failure, Nitroglycerin, Pulmonary edema
SUPPORTING INFORMATION
Author Contributions
Fermín López-Rivera - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hector Cintrón Col - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Christian Castillo LaTorre - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alexis Rivera González - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Omar Méndez Melé - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Vanessa Fonseca Ferrer - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nicolas Cruz Dardiz - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Edgar Vázquez Vargas - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hernán González Monroi - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this study.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 FermÃn López-Rivera et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
