Pulmonary edema
The content of the article:
- Causes
- Classification
- Development mechanism
- Pulmonary edema symptoms
- Diagnostics
- Pulmonary edema treatment
- Consequences of pulmonary edema
- Forecast
- Video
Pulmonary edema (pulmonary edema) is a clinical syndrome associated with the accumulation of excess fluid in the interstitial tissue and / or alveoli and manifested by impaired gas exchange in the lungs, acidosis (displacement of the acid-base blood reserve to the acidic side) and hypoxia of organs and tissues.
Pulmonary edema is a life-threatening condition and an indication for urgent hospitalization
This pathological condition most often develops in adults over 40 years old. It can complicate the course of various diseases in cardiology, pulmonology, obstetrics, pediatrics, otolaryngology, gastroenterology, neurology, urology.
Causes
In cardiology, OB is observed as a complication of the following diseases:
- acute myocardial infarction;
- cardiosclerosis (postinfarction, atherosclerotic);
- arterial hypertension;
- arrhythmias;
- cardiomyopathy;
- infective endocarditis;
- myocarditis;
- cardiac tamponade;
- heart failure;
- myxomas of the heart (benign tumors):
- heart defects (congenital and acquired).
In pulmonology, OB can also develop in many pathological processes:
- severe bronchitis and croupous pneumonia;
- emphysema;
- pneumosclerosis;
- tuberculosis;
- bronchial asthma;
- actinomycosis;
- pulmonary heart;
- thromboembolism of the pulmonary artery or its large branches;
- tumor processes;
- chest trauma;
- pneumothorax;
- pleurisy.
In rare cases, OB can be complicated by some infectious diseases:
- measles;
- flu;
- ARVI;
- polio;
- typhoid fever;
- scarlet fever;
- tetanus;
- whooping cough;
- diphtheria.
OB can cause in newborns:
- prematurity;
- hypoxia;
- pathology of the development of the bronchi and lungs.
Mechanical asphyxia, aspiration of gastric contents and drowning are almost always accompanied by the development of OB.
Other causes of pulmonary edema in humans can be:
- renal failure;
- nephrotic syndrome;
- acute glomerulonephritis;
- acute pancreatitis;
- cirrhosis of the liver;
- intestinal obstruction;
- traumatic brain injury;
- brain tumors;
- meningitis;
- encephalitis;
- subarachnoid hemorrhage;
- acute disorders of cerebral circulation;
- poisoning with metal salts, acids, organophosphorus compounds, salicylates, barbiturates;
- acute intoxication with drugs, nicotine, alcohol;
- endogenous intoxication against the background of sepsis, massive burns;
- acute allergic reactions (Quincke's edema, anaphylactic shock);
- eclampsia of pregnant women;
- ovarian hyperstimulation syndrome.
Pulmonary edema can also be triggered by iatrogenic causes:
- pleural puncture with rapid evacuation of a large volume of accumulated fluid;
- uncontrolled intravenous infusion;
- long-term mechanical ventilation (artificial lung ventilation) in hyperventilation mode.
Classification
Depending on the etiological factor, several types of pulmonary edema, cardiac (cardiogenic), noncardiogenic and mixed, are distinguished. In turn, noncardiogenic OB is subdivided into the following types:
- pulmonary (respiratory distress syndrome);
- allergic;
- nephrogenic;
- neurogenic;
- toxic.
Variants of the clinical course of OB are presented in the table:
| Flow option | Duration of development | Cause and outcome |
| Fulminant | A couple of minutes | It ends in death in 100% of cases. |
| Acute | 1-4 hours | It develops with anaphylactic shock, myocardial infarction. The likelihood of death is very high even with the timely start of resuscitation measures. |
| Subacute | The clinical picture is characterized by an undulating course | It occurs with endogenous intoxications (liver failure, uremia). The outcome depends on the underlying disease. |
| Protracted | From 12 hours to several days | The cause of development is chronic heart failure, chronic diseases of the bronchopulmonary system |
Development mechanism
At the heart of the pathological mechanism of development, the main role is played by violations of the membrane permeability between the alveoli and capillaries, a decrease in colloid-osmotic pressure and an increase in hydrostatic pressure in the vessels of the microvasculature.
At the initial stage, the transudate is sweated into the interstitial lung tissue. Its excessive accumulation causes the development of cardiac asthma (interstitial pulmonary edema).
A further increase in tissue edema contributes to the penetration of the transudate into the alveolar cavity, where it mixes with air to form foam. This foam interferes with normal gas exchange. This stage is called alveolar edema.
Against the background of increasing shortness of breath, there is a progressive decrease in intrathoracic pressure. This enhances blood flow to the right heart and causes the progression of stagnation in the vessels of the pulmonary circulation. In turn, this contributes to a further increase in the edema of interstitial tissues, a vicious circle is formed.
Pulmonary edema symptoms
The main signs of OB are:
- severe shortness of breath;
- participation in the act of breathing of the auxiliary muscles;
- fear of death;
- orthopnea (forced sitting position);
- cyanosis of the mucous membranes and skin;
- excessive sweating;
- cough with pink frothy sputum;
- tachycardia;
- pain in the region of the heart.
During auscultation, dry rales are heard against the background of weakened breathing (cardiac asthma) or moist fine bubbling rales, which are initially heard in the lower pulmonary regions, and then gradually spread to the apex (alveolar OB).
Diagnostics
Pulmonary edema requires differential diagnosis with the following diseases:
- pneumonia;
- hyperventilation syndrome;
- pulmonary embolism;
- bronchial asthma.
The patient, first of all, take an ECG and do a chest x-ray. Further examination includes:
- Echo-KG;
- catheterization of the pulmonary artery in order to determine the blood pressure in it;
- study of the function of external respiration;
- study of acid-base blood reserve.
Pulmonary edema treatment
If a person has symptoms of OB, then an ambulance team should be called to him immediately. Before the arrival of medical workers, people around should provide first aid to the patient. This requires:
- if the general condition allows, give the person a sitting position with the legs down;
- provide an influx of fresh air;
- apply tourniquets on the lower extremities in order to reduce the volume of circulating blood (they should be changed every 20 minutes).
Treatment of pulmonary edema is carried out in the intensive care unit of the hospital
The patient is admitted to the intensive care unit, where he receives emergency care. The treatment regimen includes:
- ultrafiltration of blood;
- aspiration of foam;
- artificial ventilation of the lungs (with a respiratory rate of over 30 per minute);
- the introduction of morphine in order to reduce emotional stress, suppress the activity of the respiratory center;
- taking nitroglycerin to unload the pulmonary circulation;
- diuretics;
- antihypertensive drugs;
- cardiac glycosides.
Treatment of the underlying disease is carried out after the relief of an attack of OB.
Consequences of pulmonary edema
Pulmonary edema can be complicated by the development of ischemic damage to internal organs. With a non-cardiogenic form of pathology, pneumosclerosis may form in the long term.
Forecast
Regardless of the cause, the prognosis for OB is always very serious. With cardiogenic pulmonary edema, mortality reaches 80%, and with respiratory distress syndrome - 60%. If the cause of OL cannot be eliminated, there is a high risk of recurrence.
Video
We offer for viewing a video on the topic of the article.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
