Intensive Care Medicine

, Volume 44, Issue 6, pp 900–903 | Cite as

Adjuvant therapy in acute heart failure

  • Tahar Chouihed
  • Alexa Hollinger
  • Alexandre MebazaaEmail author
What's New in Intensive Care


Contemporary management of acute heart failure (AHF) includes 1) early diagnosis based on signs and symptoms of AHF with measurement of circulating natriuretic peptides, 2) prompt administration of IV diuretics (40 mg of furosemide), 3) IV vasodilators, if the systolic blood pressure (> 90 mmHg) permits, and 4) correction of hypoxia (SpO2 < 94%) with oxygen or immediate noninvasive ventilation (NIV), if needed [1]. Superimposed challenges such as respiratory distress, diuretic resistance, association of AHF with acute coronary syndrome (ACS) and/or atrial fibrillation (AF), or cardiogenic shock (CS) require adjuvant therapies [1].

Contemporary management of AHF

Diagnosis and management of acute heart failure were extensively described in our recent practical guidance [2]. Natriuretic peptide measurements should be integrated into the interpretation of clinical signs and symptoms, since they are accurate to confirm or rule out AHF, and whenever possible completed with...

Supplementary material

134_2017_5010_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 158 kb)


  1. 1.
    Mebazaa A, Tolppanen H, Mueller C, Lassus J, DiSomma S, Baksyte G et al (2016) Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med 42(2):147–163CrossRefPubMedGoogle Scholar
  2. 2.
    Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S et al (2015) Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency. Eur J Heart Fail 17(6):544–558CrossRefPubMedGoogle Scholar
  3. 3.
    Matsue Y, Damman K, Voors AA, Kagiyama N, Yamaguchi T, Kuroda S et al (2017) Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure. J Am Coll Cardiol 69(25):3042–3051CrossRefPubMedGoogle Scholar
  4. 4.
    Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR et al (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364(9):797–805CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    ter Maaten JM, Valente MAE, Damman K, Hillege HL, Navis G, Voors AA (2015) Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Nat Rev Cardiol 12(3):184–192CrossRefPubMedGoogle Scholar
  6. 6.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200CrossRefPubMedGoogle Scholar
  7. 7.
    Masip J, Roque M, Sánchez B, Fernández R, Subirana M, Expósito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 294(24):3124–3130CrossRefPubMedGoogle Scholar
  8. 8.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al (2017) Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43(3):304–377CrossRefPubMedGoogle Scholar
  9. 9.
    Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al (2017) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. PubMedCrossRefGoogle Scholar
  10. 10.
    Pirracchio R, Parenica J, Resche Rigon M, Chevret S, Spinar J, Jarkovsky J et al (2013) The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis. PLoS One 8(8):e71659CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C et al (2014) Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40(12):1795–1815CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Koster G, Bekema HJ, Wetterslev J, Gluud C, Keus F, van der Horst ICC (2016) Milrinone for cardiac dysfunction in critically ill adult patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Med 42(9):1322–1335CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tarvasmäki T, Lassus J, Varpula M, Sionis A, Sund R, Køber L et al (2016) Current real-life use of vasopressors and inotropes in cardiogenic shock—adrenaline use is associated with excess organ injury and mortality. Crit Care 20(1):208CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Harjola V-P, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O et al (2016) Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 18(3):226–241CrossRefPubMedGoogle Scholar
  15. 15.
    Levy B, Bastien O, Karim B, Cariou A, Chouihed T, Combes A et al (2015) Experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care 5(1):52. CrossRefPubMedGoogle Scholar
  16. 16.
    Peacock WF, Emerman C, Costanzo MR, Diercks DB, Lopatin M, Fonarow GC (2009) Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail 15(6):256–264CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2017

Authors and Affiliations

  1. 1.Emergency Department, Hôpital CentralUniversity Hospital NancyNancyFrance
  2. 2.INSERM Cardiovascular Research and Development Unit 1433Vandoeuvre les NancyFrance
  3. 3.Faculty of Medicine, INSERM U1116University of LorraineVandoeuvre les NancyFrance
  4. 4.Investigation Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT)NancyFrance
  5. 5.Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain TherapyUniversity Hospital BaselBaselSwitzerland
  6. 6.U942 Inserm, Assistance Publique-Hôpitaux de Paris (AP-HP)ParisFrance
  7. 7.University Paris DiderotParisFrance
  8. 8.Department of Intensive Care MedicineHôpital LariboisièreParis CedexFrance

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