Pulmonary edema overview: Difference between revisions
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Some patients may need to use a breathing machine for a long time, which may lead to damage to [[lung]] [[tissue]].[[Kidney failure]] and damage to other major [[organs]] may occur if [[blood]] and [[oxygen]] flow are not restored promptly. If not treated, this [[condition]] can be [[fatal]]. If left untreated, acute pulmonary edema can lead to [[coma]] and even death, generally due to its main complication of [[Hypoxia (medical)|hypoxia]]. | Some patients may need to use a breathing machine for a long time, which may lead to damage to [[lung]] [[tissue]].[[Kidney failure]] and damage to other major [[organs]] may occur if [[blood]] and [[oxygen]] flow are not restored promptly. If not treated, this [[condition]] can be [[fatal]]. If left untreated, acute pulmonary edema can lead to [[coma]] and even death, generally due to its main complication of [[Hypoxia (medical)|hypoxia]]. | ||
==Chest X Ray== | ==Diagnosis== | ||
===Chest X Ray=== | |||
[[Image:Pulmonary edema.gif|right|Pulmonary edema|250px]]The diagnosis is confirmed on [[X-ray]] of the lungs, which shows increased fluid in the alveolar walls. [[Kerley B lines]], increased vascular filling, [[pleural effusion]]s, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema<ref name=Ware/> | [[Image:Pulmonary edema.gif|right|Pulmonary edema|250px]]The diagnosis is confirmed on [[X-ray]] of the lungs, which shows increased fluid in the alveolar walls. [[Kerley B lines]], increased vascular filling, [[pleural effusion]]s, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema<ref name=Ware/> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pulmonary edema is fluid accumulation in the lungs. This fluid accumulation leads to impaired gas exchange and hypoxia.
Pathophysiology
Pulmonary edema is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema"), or due to a direct injury to the lung parenchyma or increased permeability or leakiness of the capillaries ("noncardiogenic pulmonary edema").[1]
Natural History, Complications and Prognosis
Some patients may need to use a breathing machine for a long time, which may lead to damage to lung tissue.Kidney failure and damage to other major organs may occur if blood and oxygen flow are not restored promptly. If not treated, this condition can be fatal. If left untreated, acute pulmonary edema can lead to coma and even death, generally due to its main complication of hypoxia.
Diagnosis
Chest X Ray
The diagnosis is confirmed on X-ray of the lungs, which shows increased fluid in the alveolar walls. Kerley B lines, increased vascular filling, pleural effusions, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema[1]
Echocardiography
Echocardiography is useful in confirming a cardiac or no-cardiac cause of pulmonary edema. Among cardiac causes, echocardiography can identify if systolic or diastolic dysfunction is present. Echocardiography is useful in identify if focal segment wall motion abnormalities are present which would suggest ischemia or myocardial infarction as an underlying cause. If there is a global impairment of left ventricular function, then this suggests a cardiomyopathy may be present. Echocardiography may identify the presence and severity of valvular causes of pulmonary edema including aortic stenosis, aortic insufficiency, mitral stenosis. mitral insufficiency, and hypertrophic cardiomyopathy.
Cardiac Catheterization
Insertion of a pulmonary arterial catheter (a.k.a. a Swan-Ganz catheter) may be required to distinguish between the two main forms of pulmonary edema and to help guide management[1]. In patients with cardiogenic pulmonary edema the pulmonary artery pressure will be elevated. Among patients with non-cardiogenic pulmonary edema the wedge pressure will not be elevated.
Treatment
See also the chapter on congestive heart failure.
Acute Pulmonary Edema
In patients with acute pulmonary edema, the goal is to reduce both preload and afterload and to diurese the patient. Intravenous nitroglycerin can be used to reduce both the preload and afterload. Diuretics such as furosemide or bumetanide can be used to reduce volume overload. The dose that the patient is on chronically should be doubled and administered intravenously in the setting of flash pulmonary edema. Morphine sulfate may be helpful in reducing the drive to breathe, improving patient comfort, and reducing the preload.
Oxygen therapy is required to minimize cyanosis and to maintain adequate oxygenation. High-flow oxygen, noninvasive ventilation (either continuous positive airway pressure (CPAP) or variable positive airway pressure (VPAP) may be effective[2][3]). If the simple measures are not effective then mechanical ventilation may be required.
Treatment should also be directed at managing the underlying cause of an episode of acute pulmonary edema. This would include managing as acute myocardial infarction, mitral regurgitation, aortic regurgitation, or any other condition that causes an increase in left ventricular filling pressures.
References
- ↑ 1.0 1.1 1.2 Ware LB, Matthay MA. Acute pulmonary edema. N Engl J Med 2005;353:2788-96. PMID 16382065.
- ↑ Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005;294:3124-30. PMID 16380593.
- ↑ Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet 2006;367(9517):1155-63. PMID 16616558.