PULMONARY EDEMA

BY TRIYUG BIKRAM

DEFINITION

Fluid accumulation in the lungs

caused by extravasation of fluid
from pulmonary vasculature in to
the interstitium and alveoli of the
lungs

Factors affecting the fluid accumulation in the

interstitium of the lung depends on :
Hydrostatic pressure
Oncotic pressure
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
Disruption of endothelial barrier
idiopathic or unknown

Classification
Cardiogenic pulmonary
edema
Non-cardiogenic pulmonary
edema

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

Causes of Cardiogenic PE

LV failure is the most common

cause.
LV hypertrophy and
cardiomyopathy
LV volume over load
Myocardia infarction
left ventricular outflow

Staging of PE
Stage-1 : all excess fluid can still be cleared by
lymphatic drainage.
Stage-2 : characterized by the presence of
interstitial edema.
Stage-3 : characterized by alveolar edema due
to altered alveolor- capillary permeability

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

Long term(chronic)
Paraxosomal nocturnal dyspnea
orthopnea
Rapid weight gain
Loss of appetite
fatigue
ankle and leg swelling

ON EXAMINATION
Tachycardia
Tachypnea
Confusion and Agitation
Hypertension
Cool extremities
Fine basal crepitation
CVS findings ; S3 ,accentuation of pulmonic

component of S2, jugular venous distention

Cardiogenic Vs Non-cardiogenic
Pulmonary Edema

Finding suggesting cardiogenic edema

-S3 gallop
-elevated JVP
-Peripheral edema
Findings suggesting non-cardiogenic edema
-Pulmonary findings may be relatively normal
in the early stages

Chest radiography

Cardiogenic

Cardiomegaly
Kerley B lines and loss of distinct vascular margins
Cephalization: engorgement of vasculature to the apices
Perihilar alveolar infiltrate
Pleural effusion

Non cardiogenic
-Heart size is normal
-Uniform alveolar infiltrate
-pleural effusion is uncommon
-lack of cephalization

 Hypoxemia
Cardiogenic

- due to ventilation perfusion miss

match
-respond to administration of oxygen
Non cardiogenic

-due to intrapulmonary shunting

-persist despite oxygen
supplimentation

Treatment approach
Emergence management
-Support of oxygenation and ventilation
Reduction of pre load
-loop diuretics
-nitrate
- morphine
reduction of after load and inotropic support
condition that complicate PE must be corrected
-infection
-academia
-renal failure
-anemia