19th February 2025

A 74-year-old man has a background of heart failure with reduced ejection fraction secondary to alcohol-related dilated cardiomyopathy for which he takes 2.5 mg bisoprolol, 2.5 mg ramipril, 10 mg dapagliflozin, 25 mg eplerenone and twice daily 1 mg bumetanide.

A 74-year-old man has a background of heart failure with reduced ejection fraction secondary to alcohol-related dilated cardiomyopathy for which he takes 2.5 mg bisoprolol, 2.5 mg ramipril, 10 mg dapagliflozin, 25 mg eplerenone and twice daily 1 mg bumetanide.

He presents with worsening breathlessness and is found to be in pulmonary oedema. On admission, he is requiring 15 L oxygen via a non-rebreathe mask to saturate at 96%. He is started on IV GTN and a 24-hour continuous IV furosemide infusion, with his bumetanide being suspended. On the cardiology ward he begins to desaturate further overnight to 86% with worsening breathlessness. What is the next best intervention?

Select the SINGLE most appropriate option from the list below. Select ONE option only.