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