Don't Skimp on the Nitroglycerin in SCAPE

High-dose is better than low-dose. Thank you for your attention to this matter!

This is more of a reminder than newsworthy, but it’s surprising how little evidence exists to support practice in either direction. I recall back at Lyndon B. Johnson Hospital absolutely pouring nitroglycerin into patients with acute pulmonary edema – and, to my happy surprise, this article is from my old team!

“Low-dose” is < 100µ/min and “high-dose” is simply more than that, and the study is just a retrospective, single-center tale – but it validates the aggressive approach generally recommended:

There’s not enough here to fully describe any further downstream outcomes – each method usually works out in the end – nor is there much in the way of safety outcomes reported other than small n unreliable mortality numbers.

That said, I would certainly encourage more than just 100µg/min – the ~2000µg load and ~400-800µg range is where I’d like to land – but every bit of evidence nudging people higher is welcome.