ICU · cardiovascular

Acute decompensated heart failure — comprehensive ICU management (ADHF, cardiogenic shock overlap)

Also known as ADHF · Acute heart failure · Cardiogenic pulmonary oedema · Flash pulmonary oedema · Acute decompensated heart failure · Cardiogenic shock · Warm and wet · Cold and wet · Stevenson classification · Nohria profiles · DOSE trial · CARRESS-HF · 3CPO trial · ADHERE registry · ADVOR trial

Acute decompensated heart failure (ADHF): an admission for worsening heart failure producing congestion and/or hypoperfusion. CLASSIFICATION (Nohria/Stevenson bedside profiles): congestion (WET vs DRY) x perfusion (WARM vs COLD); in the 452-patient cohort wet-warm n=222, wet-cold n=91, dry-warm n=123, dry-cold n=16, and the congested profiles predicted death or urgent transplant. PRECIPITANTS (OPTIMIZE-HF): pneumonia/respiratory process, ischaemia, arrhythmia, uncontrolled hypertension, non-adherence and worsening renal function. MANAGEMENT: oxygen only if hypoxaemic, early NIV for respiratory distress (3CPO: faster dyspnoea and metabolic improvement, no 7-day mortality difference), IV loop diuretic (DOSE) with early response assessment (HFA), IV vasodilators when SBP over 110 mmHg (ESC 2021; Cotter high-dose nitrate), noradrenaline over dopamine in cardiogenic shock (SOAP II), selective short-term MCS (IABP-SHOCK II, ECLS-SHOCK, DanGer Shock), ultrafiltration not first-line (CARRESS-HF), avoid routine morphine (ADHERE), continue beta-blockers where possible (meta-analysis) and up-titrate GDMT rapidly after discharge (STRONG-HF).

Checked against its sources on 8 Oct 2026