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Diuretic, opiate and nitrate use in severe acidotic acute cardiogenic pulmonary oedema: Analysis from the 3CPO trial

Gray, Alasdair; Goodacre, Steve; Seah, M.; Tilley, S.

Authors

Alasdair Gray

Steve Goodacre

M. Seah

S. Tilley



Abstract

Background: Drug treatments for acute cardiogenic pulmonary oedema (ACPO) have not been rigorously evaluated and recent observational data suggests some agents are related to poorer outcome. Aim: We aimed to examine the effect of treatment with diuretics, nitrates and opiates on 7-day mortality, acidosis and respiratory distress in UK Emergency Department (ED) patients with severe acidotic pulmonary oedema. Design: Analysis of data from the 3CPO trial; a multicentre randomized controlled trial. Methods: Data were analysed from patients recruited with severe acidotic pulmonary oedema to the 3CPO trial in 26 UK EDs between 2003 and 2007. The effects of these treatments on 7-day mortality, improvement in acidosis (pH change between baseline and 1 h) and improvement in respiratory distress (patient measured breathlessness using a Visual Analogue Score between baseline and 1 h) were tested using univariate logistic regression analysis, and a regression model used to adjust for confounding baseline differences. Results: Nitrates were given to 947/1048 (90.4%) patients, diuretics to 934/1049 (89.0%) patients and opiates to 541/1052 patients (51.4%). Adjusted analysis showed that opiate treatment was associated with less improvement in acidosis [difference in improvement in pH -0.022, 95% confidence interval (CI) -0.014 to -0.030, P

Citation

Gray, A., Goodacre, S., Seah, M., & Tilley, S. (2010). Diuretic, opiate and nitrate use in severe acidotic acute cardiogenic pulmonary oedema: Analysis from the 3CPO trial. QJM: An International Journal of Medicine, 103(8), 573-581. https://doi.org/10.1093/qjmed/hcq077

Journal Article Type Article
Publication Date May 28, 2010
Deposit Date Feb 11, 2011
Publicly Available Date Mar 29, 2024
Journal QJM
Print ISSN 1460-2725
Electronic ISSN 1460-2393
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 103
Issue 8
Pages 573-581
DOI https://doi.org/10.1093/qjmed/hcq077
Keywords diuretic, opiate, nitrate, acidotic, acute cardiogenic pulmonary oedema, 3CPO trial
Public URL https://uwe-repository.worktribe.com/output/979339
Publisher URL http://dx.doi.org/10.1093/qjmed/hcq077

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