Efficacy and Safety of High-dose Versus Low-dose Nitroglycerin in the Management of Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Systematic Review of Clinical Outcomes

Abstract

Objectives: To evaluate and compare the efficacy and safety of high-dose (HDN) versus low-dose nitroglycerin (LDN) in the management of SCAPE. Methods: A thorough search across four databases identified 413 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, 70 full-text articles were reviewed, with 5 studies ultimately meeting the criteria for inclusion. Results: We included five studies with a total of 153 patients with SCAPE and more than half of them 85 (55.6%) were males. Across the included studies, HDN was consistently associated with rapid symptom improvement, effective blood pressure control, and reduced need for intubation and ICU admission. Adverse effects, including hypotension, were infrequent. Compared to low-dose regimens, HDN resulted in faster relief of symptoms and was well-tolerated in most cases. Conclusion: HDN appears to be a safe and effective option in the emergency management of SCAPE. It offers faster clinical stabilization with minimal risk, suggesting it may be more suitable than traditional low-dose approaches. Further large-scale randomized trials are needed to confirm these results and guide clinical practice. Non uniformity of the doses of nitroglycerin used, even in naming as high dose of low dose among different studies is a factor to be taken into account.