Anest. intenziv. Med. 2016;27(4):237-242

Is morphine still indicated for the management of cardiogenic pulmonary oedema?Intesive Care Medicine - Special Article

R. Škulec^1,2,3,*, K. Kučera¹, J. Callerová¹, J. Knor¹, P. Merhaut¹, V. Černý^2,3,4,5

¹ Zdravotnická záchranná služba Středočeského kraje, Kladno

² Klinika anesteziologie, perioperační a intenzivní medicíny, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem

³ Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové

⁴ Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové

⁵ Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

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

Received: November 14, 2015; Accepted: December 1, 2015; Published: August 1, 2016  Show citation