Pulmonary Edema
Pulmonary Edema
Pulmonary Edema
Pulmonary
INTRODUCTION
Pulmonary oedema is a condition that results from the
accumulation of fluid in the lung interstitium and
alveoli.
Fluid congestion decreases gas exchange across the
alveoli, resulting in decreased oxygenation of the blood
and, in some cases, accumulation of carbon dioxide
(CO2).
Pathophysiology
The pathophysiology of pulmonary
oedema can be thought of in terms of
three factors:
Fluid
Over- Heart
retention Hypertensio Atherosclero Aortic valve
infusion of IV muscle
(Renal n sis stenosis
fluid damage
failure)
LeftSOsidedWHAT Blood
HAPPENSbacking up in WHEN Pulmonary
THE HEART IS NOT
heart the pulmonary veins capillary
ABLE TO EJECT THE BLOOD SUFFICIENTLY Pulmonary
?edema
problems left atrial pressure and hydrostatic
Such as LV pulmonary venous pressure pressure
infarction, LV rise because of accumulating increases
failure, or mitral blood
stenosis.
Fluid
The blood passing through the lungs must have
enough oncotic pressure to hold on to the
fluid portion as it passes through the
pulmonary capillaries.
As albumin is a key determinant of oncotic
pressure, low albumin states lead to pulmonary
oedema, e.g. burns, liver failure, nephrotic
syndrome.
Filter
The capillaries through which the fluid
passes may increase in permeability, e.g.,
acute lung injury (as in smoke inhalation),
pneumonia or drowning.
Classification
Cardiogenic (or hydrostatic) pulmonary oedema
caused by an elevated pulmonary capillary pressure
from left-sided heart failure
Non-cardiogenic pulmonary oedema
Intravenous loop diuretic (e.g.,furosemide, initially 0.51.0 mg/kg); use lower dose if pt
does not take diuretics chronically.
Consider nesiritide (2-g/kg bolus IV followed by 0.01 g/kg per min) for refractory
symptomsdo not use in acute MI or cardiogenic shock.
3. INOTROPIC AGENTS
Inotropic agents are indicated in cardiogenic
pulmonary edema and severe LV dysfunction:
dopamine,dobutamine,milrinone
4. TREAT THE CAUSE
The precipitating cause of cardiogenic pulmonary
should be sought and treated, particularly acute
arrhythmias or infection.
For refractory pulmonary edema associated with
persistent cardiac ischemia, early coronary
revascularization may be life-saving.
Reexpansion pulmonary edema can develop after removal of air or fluid that has been
in the pleural space for some time. These patients may develop hypotension oroliguria
resulting from rapid fluid shifts into the lung. Diuretics and preload reduction are