FERRARI

Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High‐Risk Pulmonary Embolism

Ferrari E. Lung (2022); DOI:10.1007/s00408-022-00530-5

Clinical Question
-  In adult patients with acute pulmonary embolism and right heart strain does a strategy of volume expansion or early diuretic therapy result in a more rapid resolution of troponin levels?

N = 60, multicentre study in Europe

Authors’ Conclusions
-  A single intravenous bolus of 40 mg furosemide was well-tolerated
-  Compared with volume expansion, intravenous diuretic therapy modifies neither Tn kinetics nor RV echocardiographic parameters but accelerates BNP normalization, and reduction in sPAP and IVC diameter significantly
-  These findings, which need to be confirmed in trials with clinical end points, may translate to a rapid improvement in RV function using one-shot diuretic

The Bottom Line
-  When performing ECHO routinely on patients with PE,  right ventricular dysfunction is present in a high proportion (33% in this study)
-  Diuretics will likely reduce right atrial pressure and pulmonary artery pressure when given to these patients but it is not clear this will change outcomes
-  I will continue to aim to provide a tailored approach to maintain cardiac output in patients with PE – this may include modifying pre-load with fluid or diuretics, contractility with inodilators, and afterload with vasodilators and anticoagulants