Question: I have a question regarding nitro use with lung cancer patients. I recently had a patient who was obviously in the end stages of lung CA. Patient was complaining of mild SOB due excessive amounts of fluid buildup in his lungs. He stated that he needed to go to the hospital to have the fluid drained. Patent had 5-6 word dyspnea, O2 sats at 92 %, radial pulse 90, NSR, respiratory rate 22 regular, audible crackles when patient took a deep breath, and B/P 124/86. Patient stated that within the last couple of days he had noticed swelling to his ankles and abdomen which were abnormal for him. Patient had a previous history of nitro use due to angina. Would this patient benefit at all with nitro use? He wasn't in severe respiratory distress nor did he require assisted ventilations.

Thanks for your excellent question. The answer depends upon your clinical decision as to whether you believe this patient had acute cardiogenic pulmonary edema (crackles on exam, edema peripherally) or if you felt an alternate diagnosis was more likely (malignant pleural effusion, pneumonia due to obstruction and retained secretions).

Given the malignancy and the past history of "having the fluid drained", it is entirely possible that this patient was short of breath due to a pleural effusion from the lung cancer. In this situation, the use of nitroglycerin would not be indicated.

If you felt strongly based upon your assessment that this patient was indeed suffering moderate to severe respiratory distress related to acute cardiogenic pulmonary edema, then you would have been supported in following your medical directive for this situation.

Acute Cardiogenic Pulmonary Edema,Cardiac/Circulation

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