PULMONARY EDEMA
A CONDITION CHARACTERIZED BY
FLUID ACCUMULATION IN THE LUNGS
CAUSED BY EXTRAVASATION OF FLUID
FROM PULMONARY VASCULATURE
INTO THE INTERSTITIUM AND ALVEOLI
OF THE LUNGS
REGULATING FORCES
HYDROSTATIC PRESSURE
-FAVORS MOVEMENT OF FLUID FROM THE
CAPILLARY INTO THE INTERSTITIUM
ONCOTIC PRESSURE
-FAVORS MOVEMENT OF FLUID INTO THE VESSEL
MAINTENANCE
-LYMPHATIC IN THE TISSUE CARRY AWAY THE SMALL
AMOUNTS OF PROTEIN THAT MAY LEAK OUT
-TIGHT JUNCTION OF ENDOTHELIUM ARE
IMPERMEABLE TO PROTEIN
PATHOPHYSIOLOGY
IMBALANCE OF STARLING FORCE
-INCREASE PULMONARY CAPILLARY
PRESSURE
-DECREASE PLASMA ONCOTIC
PRESSURE
-INCREASE NEGATIVE INTERSTITIAL
PRESSURE
DAMAGE TO ALVEOLAR- CAPILLARY BARRIER
LYMPHATIC OBSTRUCTION
ETIOLOGY
IMBALANCE OF STARLING FORCE
A. RAISED PULMONARY CAPILLARY PRESSURE
-LEFT VENTRICULAR FAILURE
-VOLUME OVERLOAD
B. DECREASED PLASMA ONCOTIC PRESSURE
- HYPOALBUMINEMIA
C. HIGH NEGATIVE INTERSTITIAL PRESSURE
-RAPID REMOVAL OF PNEUMOTHORAX
ALTERED ALVEOLAR-CAPILLARY
MEMBRANE PERMEABILITY
o INHALED TOXINS
o CIRCULATING FOREIGN SUBSTANCES
o ASPIRATION
o ENDOGENOUS VASOACTIVE SUBSTANCES
o DISSEMINATED INTRAVASCULAR COAGULATION
o IMMUNOLOGIC—HYPERSENSITIVITY
PNEUMONITIS, DRUGS
LYMPHATIC INSUFFICIENCY
-AFTER LUNG TRANSPLANT
- LYMPHANGITIC CARCINOMATOSIS
-FIBROSING LYMPHANGITIS
UNKNOWN OR INCOMPLETELY
UNDERSTOOD
- HIGH-ALTITUDE PULMONARY EDEMA
- NEUROGENIC PULMONARY EDEMA
- NARCOTIC OVERDOSE
- PULMONARY EMBOLISM
CLASSIFICATION
o CARDIOGENIC PULMONARY EDEMA
o NON-CARDIOGENIC PULMONARY EDEMA
o NEUROGENIC PULMONARY EDEMA
o REEXPANSION PULMONARY EDEMA
o HIGH ALTITUDE PULMONARY EDEMA
CAUSES OF CARDIOGENIC PE
0 LV FAILURE
0 DYSRHYTHMIA
0 LV HYPERTROPHY AND CARDIOMYOPATHY
0 LV VOLUME OVER LOAD
NON CARDIOGENIC PE
0 INCREASED ALVEOLAR–CAPILLARY
MEMBRANE PERMEABILITY
0 DECREASED PLASMA ONCOTIC PRESSURE
0 DESTRUCTION OF SURFACTANT
0 LYMPHATIC INSUFFICIENCY OR OBSTRUCTION
NEUROGENIC PULMONARY EDEMA
PATIENTS WITH CENTRAL NERVOUS
SYSTEM DISORDERS AND WITHOUT
APPARENT PREEXISTING LV DYSFUNCTION
RE-EXPANSION PULMONARY EDEMA
DEVELOPS AFTER REMOVAL OF AIR OR
FLUID THAT HAS BEEN IN PLEURAL SPACE
FOR SOME TIME, POST- THORACENTESIS
HIGH ALTITUDE PULMONARY EDEMA
OCCURS IN YOUNG PEOPLE WHO HAVE
QUICKLY ASCENDED TO ALTITUDES ABOVE
2700M AND THEN PERFORM RIGOROUS
EXERCISE
STAGING OF PE
MILD: ONLY ENGORGEMENT OF PULMONARY
VASCULATURE IS SEEN.
MODERATE: THERE IS EXTRAVASATION OF FLUID
INTO THE INTERSTITIAL SPACE DUE TO CHANGES
IN ONCOTIC PRESSURE.
SEVERE: ALVEOLAR FILLING OCCURS.
CLINICAL MANIFESTATION
0 ACUTE (SUDDEN)
0 CHRONIC (LONG-TERM)
ACUTE SYMPTOMS
0 SHORTNESS OF BREATH
0 A FEELING OF SUFFOCATION
0 ANXIETY ,RESTLESSNESS
0 COUGH WITH FROTHY SPUTUM
0 EXCESSIVE SWEATING
0 PALE SKIN
0 CHEST PAIN
0 PALPITATION
LONG TERM(CHRONIC)
0 PARAXOSOMAL NOCTURNAL DYSPNEA
0 ORTHOPNEA
0 RAPID WEIGHT GAIN
0 LOSS OF APPETITE
0 FATIGUE
0 ANKLE AND LEG SWELLING
DIAGNOSIS
LABORATORY INVESTIGATIONS
ROUTINE; CBC
ARTERIAL BLOOD GAS ANALYSIS
SERUM CARDIAC BIOMARKERS
IMAGING
CHEST RADIOGRAPHY
ULTRASOUND
ECHOCARDIOGRAPHY
• PULMONARY ARTERY CATHETERIZATION
PULMONARY CAPILLARY WEDGE
PRESSURE < 18 MMHG IS CONSISTENT WITH A
NON-CARDIOGENIC CAUSE.
PULMONARY CAPILLARY WEDGE
PRESSURE >20 MMHG FAVORS A
CARDIOGENIC CAUSE.
TREATMENT
EMERGENCY MANAGEMENT
-OXYGEN THERAPY
-POSITIVE PRESSURE VENTILATION
0 REDUCTION OF PRE LOAD
-LOOP DIURETICS
-NITRATE
- MORPHINE
REDUCTION OF AFTER LOAD AND
INOTROPIC SUPPORT
CONDITION THAT COMPLICATE PE MUST BE
CORRECTED
-INFECTION
-ACIDEMIA
-RENAL FAILURE
-ANEMIA
