Low-dose versus high-dose intravenous nitroglycerin in the treatment of sympathetic crashing acute pulmonary oedema: a systematic review and meta-analysis focusing on efficacy, safety and outcomes
Abstract
Objectives: Sympathetic crashing acute pulmonary oedema (SCAPE) is a menacing medical emergency and a severe form of acute heart failure that requires urgent intervention. Nitroglycerin (NTG) is commonly used in SCAPE management, but the optimal dosing remains uncertain. This meta-analysis compared the efficacy and safety of high-dose vs low-dose NTG in SCAPE patients, assessing mechanical ventilation need, symptom resolution, hospital stay and major adverse cardiovascular events (MACE).
Design: Systematic review and meta-analysis conducted per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, registered in Prospective Register of Systematic Reviews (CRD42024527486).
Data sources: A comprehensive search in PubMed, Europe PMC and ScienceDirect up to November 2024. Reference lists of included studies were also reviewed.
Eligibility criteria: Randomised controlled trials (RCTs) and observational studies comparing high-dose NTG (≥100 mcg/min) with low-dose NTG (<100 mcg/min) in SCAPE patients were included. Key inclusion criteria were acute dyspnoea (<6 hours), systolic blood pressure (SBP) ≥160 mmHg, mean arterial pressure (MAP) ≥120 mmHg, respiratory rate (RR) ≥30 breaths/min and sympathetic activation. Exclusion criteria included non-cardiogenic pulmonary oedema, immediate intubation, NTG contraindications, pregnancy and acute coronary syndrome.
Data extraction and synthesis: Two authors independently screened the titles and abstracts of…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 185 participants or records.
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