{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:02:05Z","timestamp":1789567325132,"version":"build-2803163510"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Sympathetic Crashing Acute Pulmonary Edema (SCAPE) is a life-threatening form of acute heart failure requiring immediate management with noninvasive ventilation (NIV) and vasodilator therapy. Although nitroglycerin (NTG) is commonly used, optimal dosing remains uncertain. Emerging evidence suggests high-dose NTG may provide rapid clinical improvement. We aimed to evaluate the safety and efficacy of high-dose intravenous NTG in patients presenting with SCAPE to the emergency department (ED).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a prospective observational study in a high-volume, busy ED, enrolling adults (&gt;18 years) meeting established diagnostic criteria for SCAPE who received an initial intravenous NTG bolus \u2265400 \u03bcg. Patients with acute coronary syndrome, trauma, recent phosphodiesterase V inhibitor use, or significant aortic stenosis were excluded. Clinical status and outcomes were assessed at 3, 6, and 12 h, and at ED disposition. The primary objective was clinical outcomes (symptom resolution, need for intubation, and ED disposition) of SCAPE patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Sixty-one patients were included. The mean NTG bolus dose was 830 \u03bcg. One patient (1.6%) developed hypotension requiring fluids and brief inotropic support. Headache occurred in five patients (8.2%). Symptom resolution was observed in 10 patients (16%) at 3 h, 32 (52.5%) at 6 h, and 55 (90%) at 12 h. Five patients (8.2%) required intubation. Overall, 41 patients (67.2%) were discharged directly from the ED. The mean ED length of stay was 14 h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>High-dose intravenous NTG may improve clinical outcomes in the acute management of SCAPE, with rapid symptom resolution and reduced need for intubation. Larger studies are warranted to confirm these findings and to standardise dosing protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jets.jets_177_25","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:00:10Z","timestamp":1784260810000},"page":"144-149","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of High-dose Intravenous Nitroglycerin in Sympathetic Crashing Acute Pulmonary Edema"],"prefix":"10.4103","volume":"19","author":[{"given":"Jyothiswaroop","family":"Bhaskararayuni","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharath","family":"Gopinath","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayer","family":"Jamshed","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meera","family":"Ekka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash Ranjan","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Bhoi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tej Prakash","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"R1-20260916","doi-asserted-by":"crossref","first-page":"719","DOI":"10.4103\/0972-5229.195710","article-title":"Sympathetic crashing acute pulmonary edema","volume":"20","author":"Agrawal","year":"2016","journal-title":"Indian J Crit Care Med"},{"key":"R2-20260916","doi-asserted-by":"crossref","first-page":"1526.e5","DOI":"10.1016\/j.ajem.2018.05.013","article-title":"Recognition of sympathetic crashing acute pulmonary edema (SCAPE) and use of high-dose nitroglycerin infusion","volume":"36","author":"Paone","year":"2018","journal-title":"Am J Emerg Med"},{"key":"R3-20260916","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jemermed.2021.05.011","article-title":"High-dose nitroglycerin bolus for sympathetic crashing acute pulmonary edema: A prospective observational pilot study","volume":"61","author":"Mathew","year":"2021","journal-title":"J Emerg Med"},{"key":"R4-20260916","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.pcad.2009.10.002","article-title":"Flash pulmonary edema","volume":"52","author":"Rimoldi","year":"2009","journal-title":"Prog Cardiovasc Dis"},{"key":"R5-20260916","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/amj.2020.03.03","article-title":"Global epidemiology and future trends of heart failure","volume":"5","author":"Lippi","year":"2020","journal-title":"AME Med J"},{"key":"R6-20260916","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.annemergmed.2006.01.038","article-title":"The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: A systematic review","volume":"48","author":"Collins","year":"2006","journal-title":"Ann Emerg Med"},{"key":"R7-20260916","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.annemergmed.2007.02.022","article-title":"Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: A feasibility and outcome analysis","volume":"50","author":"Levy","year":"2007","journal-title":"Ann Emerg Med"},{"key":"R8-20260916","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.ajem.2020.03.062","article-title":"High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): A case series","volume":"44","author":"Stemple","year":"2021","journal-title":"Am J Emerg Med"},{"key":"R9-20260916","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.ajem.2022.10.018","article-title":"High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study","volume":"63","author":"Houseman","year":"2023","journal-title":"Am J Emerg Med"},{"key":"R10-20260916","first-page":"371","article-title":"Cardiogenic pulmonary edema: Mechanisms and treatment \u2013 An intensivist's view","volume":"25","author":"Ingbar","year":"2019","journal-title":"Curr Opin Crit Care"},{"key":"R11-20260916","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jchf.2019.07.008","article-title":"Lung ultrasound in acute heart failure: Prevalence of pulmonary congestion and short- and long-term outcomes","volume":"7","author":"Platz","year":"2019","journal-title":"JACC Heart Fail"},{"key":"R12-20260916","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ajem.2019.06.046","article-title":"Role of high-dose intravenous nitrates in hypertensive acute heart failure","volume":"38","author":"Wang","year":"2020","journal-title":"Am J Emerg Med"},{"key":"R13-20260916","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S0140-6736(97)08417-1","article-title":"Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema","volume":"351","author":"Cotter","year":"1998","journal-title":"Lancet"},{"key":"R14-20260916","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/emermed-2023-213285","article-title":"High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: A randomised controlled trial","volume":"41","author":"Siddiqua","year":"2024","journal-title":"Emerg Med J"},{"key":"R15-20260916","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ajem.2016.10.038","article-title":"Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure","volume":"35","author":"Wilson","year":"2017","journal-title":"Am J Emerg Med"},{"key":"R16-20260916","doi-asserted-by":"crossref","first-page":"194.e1","DOI":"10.1016\/j.ajem.2023.03.043","article-title":"Taming the tiger: Ultra high dose nitroglycerin in managing sympathetic crashing acute pulmonary edema patient","volume":"67","author":"Siddiqua","year":"2023","journal-title":"Am J Emerg Med"}],"container-title":["Journal of Emergencies, Trauma, and Shock"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_177_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:01:59Z","timestamp":1789563719000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_177_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jets.jets_177_25","relation":{},"ISSN":["0974-2700","0974-519X"],"issn-type":[{"value":"0974-2700","type":"print"},{"value":"0974-519X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-10-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}