Heart Failure, Acute With Pulmonary Oedema
General and supportive measures Medicine treatment ICD-10 code: I50.9 GENERAL AND SUPPORTIVE MEASURES Treat the underlying disorder/condition. Where the primary cause of acute pulmonary oedema is renal failure, treat as per renal failure. See: Acute kidney injury. Restrict fluids, beware of IV fluids. Place patient in an upright or semi-upright sitting position. Intubation and ventilation may be
General and supportive measures
Medicine treatment
ICD-10 code: I50.9
GENERAL AND SUPPORTIVE MEASURES
- Treat the underlying disorder/condition. Where the primary cause of acute pulmonary oedema is renal failure, treat as per renal failure. See: Acute kidney injury.
- Restrict fluids, beware of IV fluids.
- Place patient in an upright or semi-upright sitting position.
- Intubation and ventilation may be required in an ICU setting.
MEDICINE TREATMENT
- Oxygen 100%, administered via face mask, nasal cannula, CPAP or high flow.
Treat the underlying condition:
- Furosemide, IV, 1 mg/kg, 8 hourly.
- If response is inadequate, change to an IV infusion 0.1–1 mg/kg/hour.
- Switch to oral furosemide as soon as the patient’s condition allows.
- Monitor clinically and biochemically for, and avoid, overdiuresis.
- Monitor for hypokalaemia and other electrolyte disturbances.
If response still inadequate, consider:
- Hydrochlorothiazide, oral, 1 mg/kg/dose, 12 hourly in consultation with a paediatric cardiologist.
Manage severe hypotensive or refractory failure in an ICU setting.
Inotropic support may help to stabilise patients with severe myocardial dysfunction and hypotension. May be lifesaving in severe myocarditis or cardiogenic shock.
- Dobutamine, IV infusion, 2–15 μg/kg/minute.
- Continue until myocardial function and blood pressure improve.
If no response to dobutamine, consider adrenaline (epinephrine) infusion. Ensure adequate renal function.
Once patient stable and maintaining blood pressure, wean the inotrope and introduce:
- ACE-inhibitor.
Note: ACEI should be avoided in patients with obstructive heart lesions.
- Captopril, oral:
- Initial dose: 0.5–1 mg/kg/24 hours in 3 divided doses (8 hourly) for 24– 48 hours.
- Increase by 0.5 mg/kg/24 hours every 24–48 hours until maintenance dose of 3–5 mg/kg/24 hours is reached. Monitor blood pressure and renal function.
- Continue for as long as needed to control the cardiac failure and allow myocardial recovery.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 4: Cardiovascular System , 4.9 Heart Failure, 4.9.1 Heart Failure, Acute With Pulmonary Oedema