Is morphine still indicated for the management of cardiogenic pulmonary oedema?
Authors:
R. Škulec 1,2,3; K. Kučera 1; J. Callerová 1; J. Knor 1; P. Merhaut 1; V. Černý 2,3,4,5
Authors‘ workplace:
Zdravotnická záchranná služba Středočeského kraje, Kladno
1; Klinika anesteziologie, perioperační a intenzivní medicíny, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem
2; Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové
3; Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové
4; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
5
Published in:
Anest. intenziv. Med., 27, 2016, č. 4, s. 237-242
Category:
Intesive Care Medicine - Special Article
Overview
Morphine has been one of the cornerstones of the emergency pharmacological management of acute cardiogenic pulmonary oedema (CPE). However, there is only minimal evidence-based support for this strategy and some studies suggest that its administration might be associated with increased risk of need of mechanical ventilation and with higher mortality. Thus, we decided to evaluate the current knowledge on the use of morphine in the treatment of CPE, and assess the pros and cons of its use in the emergency clinical setting. At present there is no reliable evidence either supporting or rejecting the use of morphine in CPE. Therefore we conclude that morphine should not be used in this indication routinely, but after careful individual consideration only.
KEYWORDS:
acute cardiogenic pulmonary oedema – morphine
Sources
1. McMurray, J. J. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur. Heart J., 2012, 33, 14, p. 1787–1847.
2. Yancy, C. W. et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. Circulation, 2013, 128, 16, p. e240–e327.
3. Mann, D. L. , Zipes, D. P., Libby, P. B. R., Bonow, R. O. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed.: Elsevier Saunders, 2012.
4. Gandhi, S. K. et al. The pathogenesis of acute pulmonary edema associated with hypertension. N. Engl. J. Med., 2001, 344, 1, p. 17–22.
5. Mebazaa, A. et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur. J. Heart Fail. 2015, 17, 6, p. 544–558.
6. Cotter, G. et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet, 1998, 351, 9100, p. 389–393.
7. Hoel, B. L., Refsum, H. E. The effects of morphine on the arterial and mixed venous blood gas state and on the hemodynamics in patients with clinical pulmonary congestion. Acta Med. Scand., 1971, 190, 6, p. 549–554.
8. Vismara, L. A. et al. The effect of morphine on venous tone in patients with acute pulmonary edema. Circulation, 1976, 54, 2, p. 335–337.
9. Timmis, A. D. et al. Haemodynamic effects of intravenous morphine inpatiens with acute myocardial infarction compilacated by severe left ventricular failure. Br. Med. J., 1980, 280, 6219, p. 980–982.
10. Klinefelter, H. Morphine for pulmonary edema (Letter). JAMA, 1974, 229, 6, p. 638.
11. Grendahl, H. et al. The effect of intravenous morphine in patients with mitral valvular disease and congestive heart failure. Acta Med. Scand., 1973, 1–2, 1, p. 69–74.
12. Lee, G. et al. Comparative effects of morphine, meperidine and pentazocine on cardiocirculatory dynamics in patients with acutemyocardial infarction. Am. J. Med., 1976, 60, 7, p. 949–955.
13. Lee, G. et al. Hemodynamic effects of morphine and nalbuphine in acute myocardial infarction. Clinical Pharmacology and Therapeutics, 1981, 29, 5, p. 576–581.
14. Alderman, E. L. et al. Hemodynamic Effects of Morphine and Pentazocine Differ in Cardiac Patients. N. Engl. J. Med., 1972, 287, 13, p. 623–627.
15. Feeney, C. et al. Morphine Induced Cardiogenic Shock. The Annals of Pharmacotherapy, 2011, 45, 6, p. 30.
16. Llobel, F., Laorden, M. L. Effects of morphine on atrial preparations obtained from nonfailing and failing human hearts. Br. J. Anaesth., 1996, 76, 1, p. 106–110.
17. Hung, C. F., Tsai, C. H., Su, M. J. Opioid receptor independent effects of morphine on membrane currents in single cardiac myocytes. Br. J. Anaesth., 1998, 81, 6, p. 925–931.
18. Kistner, J. R. et al. Indices of myocardial oxygenation during coronary artery revascularization in man with morphine versus halothane anesthesia. Anesthesiology, 1979, 50, 4, p. 324–330.
19. Riggs, T. R., Yano, Y., Vargish, T. Opiate agonist depression of myocardial function is dose related and independent of pentoobarbital or chloral hydrate anesthesia. Am. Surg., 1986, 52, 12, p. 654–658.
20. Riggs, T. R., Yano, Y., Vargish, T. Morphine depression of myocardial function. Circ. Shock, 1986, 19, 1, p. 31–38.
21. Vargish, T. et al. Morphine sulfate depression of cardiac function is attenuated by opiate receptor antagonism with naloxone. Circ. Shock, 1987, 23, 3, p. 189–195.
22. Freye, E. Opioide in der Medizin. 8th ed.: Berlin: Springer, 2010.
23. Herz, A. Opioids I. and II. Handbook of Experimental Pharmacology. Berlin: Springer, 1993, vol. 104 I. and II.
24. Kitahata, L. M., Collins, J. G., Robinson, C .J. Narcotic Analgesics in Anesthesiology. Baltimore: Williams& Wilkins, 1982, p. 57.
25. Grossmann, M. et al. Morphine-induced venodilation in humans. Clin. Pharmacol. Ther., 1996, 60, 5, p. 554–560.
26. Durant, P. A., Yaksh, T. L. Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized animals. Anesthesiology, 1988, 68, 3, p. 325–334.
27. Kuipers, P. W. et al. Intrathecal opioids and lower urinary tract function: A urodynamic evaluation. Anesthesiology, 2004, 100, 6, p. 1497–1503.
28. Malinovsky, J. M. et al. The urodynamic effects of intravenous opioids and ketoprofen in humans. Anesthesia Analgesia, 1998, 87, 2, p. 456–461.
29. Van der Lee, R., Ceelie, I., de Wildt, S. N. Morphine-induced muscle rigidity in a term neonate. Ann. Pharmacother., 2009, 43, 10, p. 1724–1726.
30. Wardas, J., Ossowska, K., Wolfarth, S. The role of gamma-aminobutyric acid mechanisms of the zona incerta-lateral hypothalamus in the catalepsy and muscle rigidity evoked by morphine. Brain Research, 1987, 408, 1–2, p. 363–366.
31. Beltrame, J. F. et al. Nitrate therapy is an alternative to furosemide/morphine therapy in the management of acute cardiogenic pulmonary edema. J. Card. Fail., 1998, 4, 4, p. 271–279.
32. Peacock, W. F. et al. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg. Med. J., 2008, 25, 4, p. 205–209.
33. Iakobishvili, Z. et al. Use of intravenous morphine for acute decompensated heart failure in patients with and without acute coronary syndromes. Acute Card. Care, 2011, 13, 2, p. 76–80.
34. Fiutowski, M. et al. Relationship of medical therapy and survival in patients after acute cardiogenic pulmonary oedema. Polski Przeglad Kardiologiczny, 2003, 5, 4, p. 409–414.
35. Sacchetti, A. et al. Effect of ED management on ICU use in acute pulmonary edema. Am. J. Emerg. Med., 1999, 17, 6, p. 571–574.
36. Hoffman, J. R., Reynolds, S. Comparison of nitroglycerin, morphine and furosemide in treatment of presumed pre-hospital pulmonary edema. Chest, 1987, 92, 4, p. 586–593.
37. Svoboda, J. et al. Acute heart failure in pre-hospital care. Results from CARE PRE-H registry. Exp. Clin. Cardiol., 2014, 20, 8, p. 3604–3620.
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Anaesthesiology and Intensive Care Medicine
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