Cardiogenic pulmonary edema: Mechanisms and treatment - An intensivist's view

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Purpose of review: This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. Recent findings: The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with echocardiography and other testing. Summary: Treatments must be initiated early, whereas evaluation still is occurring and requires multimodality intervention. The general treatment of cardiogenic pulmonary edema includes diuretics, possibly morphine and often nitrates. The appropriate use of newer approaches - such as, nesiritide, high-dose vasodilators, milrinone, and vasopressin receptor antagonists - needs larger clinical trials.

Original languageEnglish (US)
Pages (from-to)371-378
Number of pages8
JournalCurrent opinion in critical care
Issue number4
StatePublished - Aug 1 2019

Bibliographical note

Funding Information:
This work was supported by the Pulmonary, Allergy, Critical Care and Sleep Division of the University of Minnesota Medical School Department of Medicine and by the University of Minnesota Center for Lung Science & Health.

Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


  • acute heart failure
  • alveolar fluid clearance
  • flash pulmonary edema
  • noninvasive ventilation
  • pulmonary edema


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