Abstract:
Patients suffering from acute pulmonary edema commonly require
intubation until treatments take effect. However, using rapid repeated
buccal administrations of nitroglycerin ointment can almost always
prevent intubation by rapidly reducing pre- and afterload as long as
systolic blood pressure is adequate, and the patient is not in
cardiogenic shock. In this manuscript, 6 patients presented who were in
severe pulmonary edema and needed immediate mechanical ventilatory
support, but intubation was aborted in all of them by repeated rapid
administration of buccal nitroglycerin ointment. Approximately a quarter
of an inch of nitroglycerin ointment (nitro paste) was buccally
administrated every 60 seconds as long as repeated blood pressure
measurements before each repeated administration remained above 110
mmHg. This case series is followed by a review of the literature.