Everything about Pulmonary Oedema totally explained
Pulmonary edema (American English), or oedema (British English), is swelling and/or fluid accumulation in the
lungs. It leads to impaired gas exchange and may cause
respiratory failure. It is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung
parenchyma ("noncardiogenic pulmonary edema"). Treatment depends on the cause, but focuses on maximizing respiratory function and removing the cause.
Signs and symptoms
Symptoms of pulmonary edema include
difficulty breathing,
coughing up blood,
excessive sweating,
anxiety, and
pale skin. A classical sign of pulmonary edema is the production of pink frothy sputum. If left untreated, it can lead to coma and even death, in general, due to its main complication of
hypoxia.
If pulmonary edema has been developing gradually, symptoms of fluid overload may be elicited. These include
nocturia (frequent urination at night), ankle
edema (swelling of the legs, in general, of the "pitting" variety, wherein the skin is slow to return to normal when pressed upon),
orthopnea (inability to lie down flat due to breathlessness), and
paroxysmal nocturnal dyspnea (episodes of severe sudden breathlessness at night).
Diagnosis
In general, pulmonary edema is suspected due to findings in the medical history, such as previous cardiovascular disease, and
physical examination: End-inspiratory crackles (sounds heard at the end of a deep breath) on auscultation (listening to the breathing through a
stethoscope) are characteristic for pulmonary edema. The presence of a third heart sound (S3) is predictive of cardiogenic pulmonary edema.
Therapy
Focus is initially on maintaining adequate oxygenation. This may happen with high-flow oxygen, noninvasive ventilation (either
continuous positive airway pressure (CPAP) or
variable positive airway pressure (VPAP)) or
mechanical ventilation in extreme cases.
When circulatory causes have led to pulmonary edema, treatment with intravenous nitrates (
glyceryl trinitrate), and
loop diuretics, such as
furosemide or
bumetanide, is the mainstay of therapy. These improve both preload and afterload, and aid in improving cardiac function.
There are no causal therapies for direct tissue damage; removal of the causes (for example, treating an infection) is the most important measure.
Further Information
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