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Nesiritide Treatment of Noncardiogenic Pulmonary Edema

Nurse Practitioner, Midlands Cardiology, Associates, Columbia, SC

Thomas F Oppelt, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of South Carolina, Columbia

Thadd C Hirshy, PharmD

Pharmacy Practice Resident, Department of Pharmaceutical Services, Palmetto-Richland Memorial Hospital, Columbia

Reprints: Thomas F Oppelt PharmD, Department of Pharmacy Practice, College of Pharmacy, 700 Sumter St., University of South Carolina, Columbia, SC 29208-0001, FAX 803/777-1944, E-mail Oppelt{at}cop.sc.edu

OBJECTIVE: To report the efficacy of nesiritide in treating noncardiogenic pulmonary edema.

CASE SUMMARY: A 50-year-old African American woman with a complex medical history including morbid obesity, acute bronchitis, obstructive sleep apnea, hypertension, and numerous hospitalizations for volume overload presented to the emergency department with severe dyspnea. A portable chest X-ray displayed perihilar congestion and bilateral pulmonary edema. An echocardiogram demonstrated normal left-ventricular systolic and diastolic function. She was aggressively treated with nitrates, diuretics, bronchodilators, and oxygen. Despite these efforts, the patient's arterial blood gas (ABG) continued to show respiratory acidosis, the oxygen saturation was significantly depressed, and the dyspnea continued. Since standard therapies were failing after 12 hours, the patient was treated with intravenous nesiritide. The results were profound in terms of rapid symptomatic and prognostic improvement (i.e., ABG) beginning within 45 minutes of administration, and the patient was discharged after a 5-day hospital course.

DISCUSSION: Nesiritide is a human B-type natriuretic peptide that has been shown to improve hemodynamic function and symptoms associated with decompensated heart failure. This is primarily due to the actions of this medication, including diuresis, decreased mean arterial pressure, and improvement of pulmonary arterial occlusion pressure as determined by published clinical trial outcomes. This case describes the use of nesiritide as an effective adjunctive therapy in treating a patient with noncardiogenic pulmonary edema.

CONCLUSIONS: Nesiritide appears to be an efficacious treatment for acute pulmonary edema, resistant to standard-of-care therapies, in the presence of normal left-ventricular function.

Key Words: B-type natriuretic peptide, nesiritide, pulmonary edema

Published Online, March 6, 2003. www.theannals.com, DOI 10.1345/aph.1C331

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