High-Dose Nitroglycerin in Managing Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Comprehensive Review of Recent Evidence and Clinical Outcomes

TL;DR

High-dose nitroglycerin improves outcomes in a severe form of acute pulmonary edema, with fewer complications and faster recovery.

Contribution

This review provides new evidence supporting high-dose nitroglycerin as a safe and effective treatment for SCAPE.

Findings

High-dose nitroglycerin reduces ICU admission and intubation rates in SCAPE patients.

Symptoms resolve faster with HDN, and hospital stays are shorter compared to low-dose therapy.

Fewer adverse effects and major cardiac events are observed with HDN treatment.

Abstract

This review evaluated recent clinical evidence on the management of sympathetic crashing acute pulmonary edema (SCAPE) with high-dose nitroglycerin (HDN) therapy. Several recent studies, including randomized controlled trials and cohort studies, were analyzed to assess the efficacy and safety of HDN compared with low-dose nitroglycerin (LDN). Across studies, HDN was associated with improved clinical outcomes, including reduced rates of ICU admission, intubation, and acute kidney injury; shorter hospital stays; a lower incidence of major adverse cardiac events; and more rapid achievement of blood pressure targets. Symptom resolution within six hours was consistently reported, and most patients were discharged without complications. Adverse effects, such as hypotension, were infrequent. Collectively, these findings support the use of HDN as a safe and effective intervention for SCAPE, warranting further large-scale randomized trials to confirm these promising results.