Morphine, Midazolam and Dexmedetomidine in The Management of Acute Cardiogenic Pulmonary Edema: Safety and Efficacy

Background: Acute cardiogenic pulmonary edema (ACPE) is a stressful scenario characterized by progressive respiratory failure that can result in cardiorespiratory collapse . we aimed to compare Midazolam, Morphine and Dexmedetomidine in ACPE regarding efficacy and safety. Methods: 84 Adult subjects with clinical diagnosis of ACPE with anxiety and severe dyspnea were included in the present study devided to three equal groups.We assessed respiratory rate, heart rate, oxygen saturation systolic blood pressure, and dyspnea score, on arrival (baseline) and 6 hours after admission to evaluate clinical improvement. Bed side echocardiography and Lung ultrasound were done. The clinical improvement during length of ICU stay is the primary outcome, while the reporting of Serious Adverse Event (SAE) is considered the main safety endpoint. Results: There was a statistically insignificant variance among study groups; according to past medical history, chronic treatment, management in emergency department, RR, SPO₂, sedation scale, EF, diastolic dysfunction, lung US, on admission & follow up IVC diameter and laboratory findings, mechanical ventilation, in-hospital Mortality and 30-days Mortality. There was statistically significant diminution in heart rate, ICU stay and Ward stay in Dexmedetomidine Group in comparison with Morphine and Midazolam Groups. There was a statistically significant variance among study groups; regarding ICU and Ward stay. Conclusion: Dexmedetomidine seemed to be of superior advantage over both Morphine, Midazolam regarding ICU stay and Ward stay, however both Morphine, Midazolam revealed an advantage over Dexmedetomidine concerning dyspnea and sedation scales. Keyword: Morphine, Midazolam, Dexmedetomidine, Acute Cardiogenic Pulmonary Edema