Cite this post as:
Scott Weingart, MD FCCM. When to wean the CPAP in SCAPE. EMCrit Blog. Published on October 20, 2011. Accessed on April 26th 2024. Available at [https://emcrit.org/emcrit/when-to-wean-cpap-scape/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: October 20, 2011
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Ok, So I have the weaning idea (I’m lucky in that I have really good RT to help me). But my question is what is the role of ACE inhibition in SCAPE. We have one ICU doc who seems to think they are the answer to SCAPE. I just spent some time looking at the literature and reviewing the physiology and I’m not sure that we don’t already fix this problem. By decreasing afterload and SVR with nitro and work of breathing (read: adrenergic tone) with NIV, the triggers for increased RAAS activation have been eliminated. Why block things downstream?… Read more »
Used to use ACEI, when I attendings were too scared to let me go up on the Nitro. Now I’d rather have something infinitely titratable (nitro drip) in the early phases. I will add on an ACEI to get a patient off of nitro drip to let them go to a tele bed where they won’t take nitro drips. Put them on some paste and give them some IV ACEI and good to go. There have been a few studies showing efficacy and I believe 1, not so much. They should be on http://crashingpatient.com
Very nice- your real life advice based on data is way better than the paper bashing journal clubs the residents are getting used to.
I will say that I’ve gone to IV ACEs when the BP is very labile with my ntg drip. And I’m almost never up at your SCAPE doses. Pretty much btw 50 and 100mcg. Thoughts?
-pik
Hey Pik, discussed IV ACE in podcast 1; doses of nitro depend on how far gone the patient is.