Optimized Treatment of Pulmonary Edema or Congestion (Decongest)
Pulmonary Edema, Congestive Heart Failure, Acute Heart Failure
About this trial
This is an interventional treatment trial for Pulmonary Edema focused on measuring acute heart failure, Pulmonary edema
Eligibility Criteria
Inclusion criteria
- Age ≥ 18 years
- Acute (within minutes to days) onset or worsening of subjective dyspnea*
- Systolic blood pressure ≥100 mmHg
- Oxygen saturation <94% or need of oxygen
Signs or suspicion of congestion (peripheral edema, rales, and/or clinical suspicion of congestion) *
- by the best assessment from a medical doctor. Inclusion must not wait on x-ray or other measures: patients suspected of pulmonary congestion should be included immediately.
Exclusion criteria
- More than 40 mg IV furosemide within the last three hours before randomization including prehospital treatment.
- More than 3 hours from hospital-admission to randomization
- Ongoing ventricular taky- or brady-arrythmias or supraventricular arrhythmias with HR > 180 or < 40 bpm.
- Suspected severe infection or sepsis.
Exclusion criteria are purposely liberal, so patients can be included in accordance with everyday clinical practice. However, a safety criterion will be implemented:
If blood pressure drops below 90 mmHg in 2 measurements with 5 minutes apart and/or if urine production is below 50 ml after 1 hour, the intervention will be stopped, and patients can receive furosemide and nitrates freely.
We purposely chose not to exclude patients with aortic stenosis, since observational studies did not find excess risk of given nitrates to patients with pulmonary edema and aortic stenosis
Sites / Locations
- Bispebjerg HospitalRecruiting
- Hvidovre HospitalRecruiting
- Roskilde Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Active Comparator
Active Comparator
Furosemide only
isosorbide dinitrate
isosorbide dinitrate + furosemide
• Boluses of 40 mg furosemide given as soon as possible and repeated up to 10 times by the discretion of the treating physician.
• Boluses of 3 mg IV isosorbide dinitrate given as soon as possible and repeated up to 10 times by the discretion of the treating physician.
• Boluses of both 3 mg IV isosorbide dinitrate + of 40 mg furosemide given as soon as possible and repeated up to 10 times by the discretion of the treating physician.