Management of Acute Pulmonary Edema in the Intensive Care Unit
Maie Marouf Talha Ghanem;
Abstract
Acute pulmonary edema is defined as fluid accumulation in the lungs, that leads to dyspnea, respiratory failure and even death that requires immediate intervention and emergency treatment.
The lung surface is formed of two types of epithelium; pulmonary epithelium and alveolar epithelium. pulmonary epithelium present in all surface epithelia of the conducting airways, composing of different cell types; which consist mainly of ciliated cells, Clara cells, undifferentiated basal cells, and goblet cells, responsible for the transport of inhaled particles and the mucous layer and secrete some ions and proteins.
The alveolar epithelium mainly function is efficient gas and water exchange through the thin side and thick side of the alveolar capillary membrane. and also have a role in immune defense responses in the lung by having alveolar type I (ATI) and type II (ATII) Cells.
Acute pulmonary edema compose of two types: cardiogenic and non- cardiogenic pulmonary edema.
Cardiogenic pulmonary edema results from increase pulmonary capillary hydrostatic pressures, which occur due to mainly cardiac problem like; left ventricular dysfunction, with or without additional cardiac pathology, such as coronary artery disease or valve abnormalities. however, a variety of conditions cardiogenic pulmonary edema in the absence of heart disease, including primary fluid overload; due to blood transfusion, severe hypertension, renal artery stenosis, and severe renal disease.
Non-cardiogenic pulmonary edema or high permeability edema is occur due to injury of the alveolar-capillary barrier with leakage of protein-rich fluid into the interstitium and air spaces, in the absence of elevated pulmonary capillary wedge pressure. it occur usual with; acute respiratory distress syndrome (ARDS) and acute lung injury.
There are another less common types of non-cardiogenic pulmonary edema; the most important is; high attitude pulmonary edema, neurogenic pulmonary edema, pulmonary edema in pregnancy and negative pressure pulmonary edema.
Diagnosis of acute pulmonary edema depend on; history from the patient to reach any underlying causes, symptoms and signs like: dyspnea, orthopnea, fatigue, hypo or hypertension, any abnormalities in lung and heart examination.
Diagnosis depends also on laboratory testing like; plasma levels of brain natriuretic peptide (BNP), arterial blood gas analysis, complete blood count and serum electrolyte measurements. some radiological examination; chest -x-ray, CT scanning, echocardiography and pulmonary-artery catheterization.
Pulmonary edema should differentiate from other causes of dyspnea like; pneumonia, fat emboli, sepsis, shock, multiple transfusions, acute pancreatitis, anaphylactic shock, myocardial ischemia, pneumothorax, pulmonary embolism, respiratory failure, acute coronary syndrome, asthma, bronchitis, cardiogenic Shock, chronic obstructive pulmonary disease, and emphysema.
Treatment of acute pulmonary edema is emergency first to maintain patient life; through ABC of resuscitation, apply of oxygen by nasal mask or mechanical ventilation. the blood pressure may need to be supported with medications until the breathing status improves. when the patient is stabilized begin to assess the underlying cause and treat it.
Post acute stage, should begun after stabilize the patient, to improve the case, by education and support for patient and his family. home assessment, changing lifestyle and diet with use of some medications according to the case. changing job duties to those with less physically activities or emotionally stressful responsibilities.
The lung surface is formed of two types of epithelium; pulmonary epithelium and alveolar epithelium. pulmonary epithelium present in all surface epithelia of the conducting airways, composing of different cell types; which consist mainly of ciliated cells, Clara cells, undifferentiated basal cells, and goblet cells, responsible for the transport of inhaled particles and the mucous layer and secrete some ions and proteins.
The alveolar epithelium mainly function is efficient gas and water exchange through the thin side and thick side of the alveolar capillary membrane. and also have a role in immune defense responses in the lung by having alveolar type I (ATI) and type II (ATII) Cells.
Acute pulmonary edema compose of two types: cardiogenic and non- cardiogenic pulmonary edema.
Cardiogenic pulmonary edema results from increase pulmonary capillary hydrostatic pressures, which occur due to mainly cardiac problem like; left ventricular dysfunction, with or without additional cardiac pathology, such as coronary artery disease or valve abnormalities. however, a variety of conditions cardiogenic pulmonary edema in the absence of heart disease, including primary fluid overload; due to blood transfusion, severe hypertension, renal artery stenosis, and severe renal disease.
Non-cardiogenic pulmonary edema or high permeability edema is occur due to injury of the alveolar-capillary barrier with leakage of protein-rich fluid into the interstitium and air spaces, in the absence of elevated pulmonary capillary wedge pressure. it occur usual with; acute respiratory distress syndrome (ARDS) and acute lung injury.
There are another less common types of non-cardiogenic pulmonary edema; the most important is; high attitude pulmonary edema, neurogenic pulmonary edema, pulmonary edema in pregnancy and negative pressure pulmonary edema.
Diagnosis of acute pulmonary edema depend on; history from the patient to reach any underlying causes, symptoms and signs like: dyspnea, orthopnea, fatigue, hypo or hypertension, any abnormalities in lung and heart examination.
Diagnosis depends also on laboratory testing like; plasma levels of brain natriuretic peptide (BNP), arterial blood gas analysis, complete blood count and serum electrolyte measurements. some radiological examination; chest -x-ray, CT scanning, echocardiography and pulmonary-artery catheterization.
Pulmonary edema should differentiate from other causes of dyspnea like; pneumonia, fat emboli, sepsis, shock, multiple transfusions, acute pancreatitis, anaphylactic shock, myocardial ischemia, pneumothorax, pulmonary embolism, respiratory failure, acute coronary syndrome, asthma, bronchitis, cardiogenic Shock, chronic obstructive pulmonary disease, and emphysema.
Treatment of acute pulmonary edema is emergency first to maintain patient life; through ABC of resuscitation, apply of oxygen by nasal mask or mechanical ventilation. the blood pressure may need to be supported with medications until the breathing status improves. when the patient is stabilized begin to assess the underlying cause and treat it.
Post acute stage, should begun after stabilize the patient, to improve the case, by education and support for patient and his family. home assessment, changing lifestyle and diet with use of some medications according to the case. changing job duties to those with less physically activities or emotionally stressful responsibilities.
Other data
| Title | Management of Acute Pulmonary Edema in the Intensive Care Unit | Other Titles | معالجة مرض الإرتشاح الرئوي الحاد في الرعايةالمركزة | Authors | Maie Marouf Talha Ghanem | Issue Date | 2015 |
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