pulmonary edema (pulmonary congestion, PE)
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Introduction
- Pulmonary edema (PE) is a condition, usually acute, but sometimes chronic, where fluid builds up in the lungs.
- This often occurs as a response to left ventricular failure in ischemic heart disease, hypertension, or aortic valve disease (cardiogenic pulmonary edema).
Etiology
- imbalance of Starling forces
- left ventricular failure
- obstruction of flow through the mitral valve
- pulmonary veno-occlusive disease (rare)
- pulmonary artery hypertension (overperfusion PE)
- hypoalbuminemia
- asthma
- altered alveolar-capillary membrane permeability, adult respiratory distress syndrome (ARDS)
- infectious pneumonia
- inhaled toxins
- circulating vascular toxins
- aspiration of acidic gastric acid contents
- acute radiation pneumonitis
- endogenous vasoactive substances (histamines, kinins)
- disseminated intravascular coagulation
- hypersensitivity pneumonitis
- shock in associated with non-thoracic trauma
- acute hemorrhagic pancreatitis
- lymphatic insufficiency
- post lung transplantation
- lymphangtic carcinomatosis
- fibrosing lymphangitis (silicosis)
- poorly understood causes
- pharmacologic causes:
Pathology
- pulmonary capillary pressure exceeds forces which maintain fluid in the intravascular space:
- altered alveolar-capillary membrane permeability
- accumulation of fluid in the pulmonary interstitium
Laboratory
- serum BNP[8]
- serum troponin-I (serial)
Diagnostic procedures
Radiology
Management
- non-invasive positive pressure ventilation reduces mortality & need for endotracheal intubation[7]
- see cardiogenic pulmonary edema
More general terms
More specific terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 130
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 761, 762, 763
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 173
- ↑ Hubble MW et al, Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care 2006, 10:430 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16997770
- ↑ 6.0 6.1 Raja AS Point-of-Care Ultrasound Can Be Used to Evaluate for Acute Pulmonary Edema NEJM Journal Watch. Sept 4, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Al Deeb M et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: A systematic review and meta-analysis. Acad Emerg Med 2014 Aug; 21:843 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25176151 - ↑ 7.0 7.1 The NNT: Non-Invasive Positive Pressure Ventilation for Acute Pulmonary Edema. http://www.thennt.com/nnt/non-invasive-positive-pressure-ventilation-for-pulmonary-edema/
Vital FM, Ladeira MT, Atallah AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2013 May 31;5:CD005351 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23728654
Masip J, Roque M, Sanchez B et al Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005 Dec 28;294(24):3124-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16380593 - ↑ 8.0 8.1 8.2 8.3 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.