Pulmonary Edema
Definition
is a condition
Pulmonary Edema ;
characterized by fluid accumulation in
the lungs caused by extravasation of
fluid from pulmonary vasculature in to
the interstitium and alveoli of the lungs
Epidemiology
Pulmonary edema occurs in about 1% to 2% of the general
population.
Between the ages of 40 and 75 years, males are affected
more than females.
After the age of 75 years, males and females are affected
equally.
The incidence of pulmonary edema increases with age and
may affect about 10% of the population over the age of 75
years.
Classification
Base on underlining cause
o Cardiogenic pulmonary edema
o Non-cardiogenic pulmonary edema
Cardiogenic pulmonary
edema
Is Pulmonary edema due to
increased pressure in the pulmonary
capillaries because of cardiac
abnormalities that lead to an
increase in pulmonary venous
pressure.
o Hydrostatic pressure is increased
and fluid exit capillary at increased
rate
Cardiogenic PE
Basic pathophysiology:
A rise in pulmonary venous and
pulmonary capillary pressures pushes
fluid into the pulmonary alveoli and
interstitium.
CXR: B/L perihilar bat’s wing
appearance,symmetric opacification
of lung fields
Pathogenesis of CPE
Left sided heart failure
Decrease pumping ability to the systemic circulation
Congestion & accumulation of blood in the pulmonary area
Fluid leaks out of the intravascular space to the interstitium
Accumulation of fluid
`
Pulmonary edema
Risk Factors
Vary by cause
Leading risk factor is clearly
-
underlying cardiac disease.
Causes of Cardiogenic PE
LV failure is the most common
cause.
Dysrhythmia
LV hypertrophy and
cardiomyopathy
LV volume over load
Myocardia infarction
left ventricular outflow
obstruction
Non cardiogenic
pulmonary edema
It is defined as the evidence of alveolar
fluid accumulation with out
hemodynamic evidence that suggest a
cardiogenic etiology.
Hydrostatic pressure is normal
Leakage of protein and other molecule
in to the tissue
Non- cardiogenic PE
cause
I. Direct injury to the lung
II. Hematogenous injury to the
lung
III. possible lung injury plus
elevated hydrostatic pressure
Symptom of pulmonary
edema
ACUTE
Shortness of breath
A Feeling of suffocating
Anxiety ,restlessness
Cough-frothy sputum that may be tinged with
blood
excessive sweating
pale skin
chest pain if PE is cause by cardiac abnormality
palpitation
Symptom……
Long term(chronic)
Paraxosomal nocturnal dyspnea
orthopnea
Rapid weight gain
Loss of appetite
fatigue
ankle and leg swelling
Signs
Tachycardia
Tachypnea
Confusion
Agitation
Anxious
Diaphoric
Hypertension
Cool extremities
Rales
Wheezing
CVS findings ; S3 ,accentuation of pulmonic
component of S2, jugular venous distention…..
Complications
leg swelling(edema),
abdominal swelling(ascites),
Pleural effusion,
Congestion & swelling of liver,
acute heart attack (myocardial infarction [MI]),
cardiogenic shock,
arrhythmias,
electrolyte disturbances,
INVESTIGATIONS
CXR-PA view:
unilateral or bilateral involvement,cardiogenic
pattern or non cardiognic pattern(air bronchogram
signs, fluffy opacities, asymmetrical inhomogenous
involvement),lobar involvement in post infectious PE.
ABG analysis:
hypoxia and hypocapnia initially with respi. alkalois
hypercapnea in later stage with respi and
metabolic acidosis
Hemodynamic measurement with Swan-Ganz
catheter
Blood work up and septic screen
Management stretagy
Treat underlying cause : Sepsis,heart failure,high
altitude hypoxia,obstruction,fluid
overload,hypoproteinemia etc.
Respi support: NIV vs Intubation f/b venti support
Management stretagy…
Principles of mechanical ventilation
Two fundamental principles
1. Prevention of overdistension of alveoli-limiting
tidal volume or inspiratory pressure
2. Choose the level of PEEP sufficiently high to
prevent derecruitment of alveoli at end of
expiration
1. Limiting tidal volume
High TV 12-15 ml per kg are
dangerous in patient with PE
Can lead to VOLUTRAUMA
Tidal volume kept at 6-8 ml per kg
to start with in patient of PE
Then adjusted to keep the plateau
pressure below 30 cm of H2O
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