Bắt đầu một truyền nitrate bắt đầu một truyền Dobutamine 5 mg / kg / phút, điều này có thể được thông qua một dòng thiết bị ngoại vi Tăng liều 2,5 mg / kg / phút mỗi 10 phút cho đến khi huyết áp tâm thu 110 mmHg hoặc liều tối đa là 20 mg / kg / phút đã đạt tới một truyền nitrat | 190 SPECIFIC PROBLEMS CARDIOVASCULAR TABLE Further drug therapy of acute cardiogenic pulmonary edema Systolic blood pressure Action 110 mmHg Give another dose of furosemide 40-80 mg IV Start a nitrate infusion 90-110 mmHg Start a dobutamine infusion at 5pg kg min this can be given via a peripheral line Increase the dose by pg kg min every 10min until systolic BP is 110 mmHg or a maximum dose of 20pg kg min has been reached A nitrate infusion can be added if systolic BP is maintained at 110 mmHg 80-90 mmHg Start a dopamine infusion at 10pg kg min this must be given via a central line Increase the dose by 5 pg kg min every 10min until systolic BP is 110 mmHg If systolic BP remains 90 mmHg despite dopamine 20 pg kg min use norepinephrine instead A nitrate infusion can be added if systolic BP is maintained at 110 mmHg 80 mmHg Start a norepinephrine infusion at pg kg min this must be given via a central line Increase the dose by pg kg min every 10min until systolic BP is 110 mmHg A nitrate infusion can be added if systolic BP is maintained at 110 mmHg TABLE Ventilatory support for respiratory failure due to cardiogenic pulmonary edema Mode of ventilation Indications Contraindications Disadvantages and complications Non-invasive ventilatory support with continuous positive airways pressure CPAP Endotracheal intubation and mechanical ventilation Oxygenation failure oxygen saturation 92 despite FiO 40 Ventilatory failure mild to moderate respiratory acidosis arterial pH Upper airway obstruction Impending respiratory arrest Airway at risk because of neurological disease or coma GCS 8 or lower Oxygenation failure PaO despite supplemental oxygen NIV Ventilatory failure moderate to severe respiratory acidosis arterial pH Recent facial upper airway or upper gastrointestinal tract surgery Vomiting or bowel obstruction Copious secretions Hemodynamic instability Impaired consciousness confusion or agitation Severely impaired functional
