Acute lung edema is a condition where fluid accumulates in the lungs, making it difficult to breathe. The POND mnemonic is a useful tool for remembering the key treatments for acute lung edema.
P: Position / PPV
The first step in treating acute lung edema is to position the patient upright or in a semi-upright position. This helps to reduce the amount of fluid in the lungs and improve breathing. Positive pressure ventilation (PPV) may also be used to help improve oxygenation in patients who are struggling to breathe.
High-flow oxygen should be administered initially to improve oxygenation. Oxygen saturation should be monitored and titrated to keep it between 92-96%. If oxygen saturation cannot be maintained within this range, CPAP or BiPAP may be used in a critical care unit or high dependency unit.
Nitroglycerin is a vasodilator that can help to reduce the workload on the heart and improve blood flow. Use nitroglycerin sublingual followed by infusion. High-dose nitroglycerin can be used to treat sympathetic crashing acute pulmonary edema (SCAPE) with SBP >160 mm Hg, but it should be used with caution in patients with low blood pressure or other contraindications. High dose NTG is 600-1000 mcg IV bolus followed by 100 mcg/min infusion, titrate as needed.
Contraindications to NTG use include severe aortic stenosis, recent use of phosphodiesterase type 5 inhibitors (e.g. sildenafil, tadalafil, vardenafil), hypertrophic obstructive cardiomyopathy, or hypotension at any time.
Diuretics are medications that help to remove excess fluid from the body. They are a key treatment for acute lung edema. Furosemide is the most commonly used diuretic in this setting. The recommended dose is 40-80 mg IV bolus, with additional doses given as needed.
Take Home Message
In summary, the POND mnemonic is a useful tool for remembering the key treatments for acute lung edema. Positioning the patient upright, administering high-flow oxygen, using high-dose nitroglycerin, and administering diuretics are all important steps in managing this condition. However, it is important to remember that treatment should be tailored to the individual patient, and that other treatments may be necessary depending on the severity of the condition and the underlying cause.