Pulmonary edema is a physiological condition of a person in which plasma from the pulmonary vessels penetrates the interstitium and alveoli, which significantly affects the quality of gas exchange between the lungs and the inhaled air, and this, in turn, leads to acute oxygen starvation of all organs of the body.

Pulmonary edema is of two types, and is divided among themselves by the pathogen:

Diagnostics

To correctly diagnose the causes of pulmonary edema, the doctor should definitely and very carefully interview the patient if he is conscious. If the patient is not conscious or cannot answer questions, then a comprehensive examination is required, during which it will be possible to suggest possible causes of edema.

Laboratory tests may also be used to make a diagnosis, including:

	A blood test that confirms or refutes the presence of infection in the body due to an increased number of platelets.
	Blood biochemistry will determine the presence of heart disease that can cause edema.
	A coagulogram with an increased amount of prothrombin will confirm swelling of the lungs due to pulmonary thromboembolism.
	Study of the gas composition of the lungs.

The patient may also be asked to undergo additional examinations to determine in more detail the cause of edema; these examinations are selected at the discretion of the doctor.

Symptoms of pulmonary edema

Symptoms of edema appear and develop very quickly. Symptoms strongly depend on the rate of penetration of plasma from the interstitium into the alveoli.

Based on the rate of plasma penetration, four different types of edema are determined:

	Spicy- in this form, the first symptoms of alveolar edema appear within 2-4 hours after the appearance of the very first symptoms of interstitial edema. The causes may be myocardial infarction and stress.
	Subacute- the duration of this edema ranges from 4 to 12 hours, usually develops due to the presence of renal or liver failure, or congenital disorders in the functioning of blood vessels.
	Protracted is swelling that lasts about 24 hours. This form of the disease appears in the presence of chronic diseases of the liver, kidneys, and lungs.
	Fulminant- such swelling is observed only after anaphylactic shock or extensive myocardial infarction and leads to rapid death.

The main symptoms include:

	Loud breathing, even in a state of physical rest, shortness of breath is observed.		A sudden feeling of acute lack of air, which intensifies in a supine position.
	Feelings of squeezing or pressing pain in the chest.		Rapid and intense heartbeat.
	Sputum production with pinkish foam when coughing.		Pale or bluish skin.
	Coma.

Basic treatment methods

Pulmonary edema is an acute condition of the body that can be fatal to a person, therefore, if any of its manifestations occur, you should immediately call for medical help. During transportation to the hospital, the patient is placed in a semi-sitting position, oxygen inhalation is performed or, in case of severe shortness of breath, an artificial respiration apparatus is installed.

Subsequent treatment is carried out in the intensive care unit or intensive care unit, where the patient is under constant supervision.

Use of oxygen concentrators

For all types of pulmonary edema it is used oxygen therapy by using oxygen concentrators. Oxygen therapy has a positive effect on all organs and cells of the human body, and especially on the heart. Taking oxygen inhalation can reduce the permeability of the pulmonary membranes, which holds plasma in the vessels and prevents them from penetrating to the alveoli.

With alveolar edema, the entire respiratory cavity is filled with pinkish foam, which prevents oxygen from entering the lungs; for this purpose, special drugs are used - defoamers, which can not only help a person receive a life-saving dose of oxygen, but also protect against asphyxia.
Take care of your health and the health of those you care about!

Thank you from the bottom of our hearts!

– acute pulmonary failure associated with massive release of transudate from the capillaries into the lung tissue, which leads to infiltration of the alveoli and a sharp disruption of gas exchange in the lungs. Pulmonary edema is manifested by shortness of breath at rest, a feeling of tightness in the chest, suffocation, cyanosis, cough with foamy bloody sputum, bubbling breathing. Diagnosis of pulmonary edema involves auscultation, radiography, ECG, echocardiography. Treatment of pulmonary edema requires intensive therapy, including oxygen therapy, administration of narcotic analgesics, sedatives, diuretics, antihypertensive drugs, cardiac glycosides, nitrates, and protein drugs.

General information

Pulmonary edema is a clinical syndrome caused by the leakage of liquid blood into the lung tissue and accompanied by impaired gas exchange in the lungs, the development of tissue hypoxia and acidosis. Pulmonary edema can complicate the course of a variety of diseases in pulmonology, cardiology, neurology, gynecology, urology, gastroenterology, and otolaryngology. If the necessary assistance is not provided in a timely manner, pulmonary edema can be fatal.

Reasons

The etiological reasons for pulmonary edema are varied. In cardiological practice, pulmonary edema can be complicated by various diseases of the cardiovascular system: atherosclerotic and post-infarction cardiosclerosis, acute myocardial infarction, infective endocarditis, arrhythmias, hypertension, heart failure, aortitis, cardiomyopathies, myocarditis, atrial myxomas. Pulmonary edema often develops against the background of congenital and acquired heart defects - aortic insufficiency, mitral stenosis, aneurysm, coarctation of the aorta, patent ductus arteriosus, ASD and VSD, Eisenmenger syndrome.

In pulmonology, pulmonary edema can be accompanied by severe chronic bronchitis and lobar pneumonia, pneumosclerosis and emphysema, bronchial asthma, tuberculosis, actinomycosis, tumors, pulmonary embolism, and cor pulmonale. The development of pulmonary edema is possible with chest injuries accompanied by prolonged crush syndrome, pleurisy, pneumothorax.

In some cases, pulmonary edema is a complication of infectious diseases that occur with severe intoxication: ARVI, influenza, measles, scarlet fever, diphtheria, whooping cough, typhoid fever, tetanus, polio.

Pulmonary edema in newborns can be associated with severe hypoxia, prematurity, and bronchopulmonary dysplasia. In pediatrics, the danger of pulmonary edema exists in any condition associated with obstruction of the airways - acute laryngitis, adenoids, foreign bodies in the respiratory tract, etc. A similar mechanism for the development of pulmonary edema is observed in mechanical asphyxia: hanging, drowning, aspiration of gastric contents into the lungs.

In nephrology, acute glomerulonephritis, nephrotic syndrome, and renal failure can lead to pulmonary edema; in gastroenterology – intestinal obstruction, liver cirrhosis, acute pancreatitis; in neurology - stroke, subarachnoid hemorrhages, encephalitis, meningitis, tumors, head injury and brain surgery.

Pulmonary edema often develops as a result of poisoning with chemicals (fluorinated polymers, organophosphorus compounds, acids, metal salts, gases), intoxication with alcohol, nicotine, and drugs; endogenous intoxication in case of extensive burns, sepsis; acute poisoning with drugs (barbiturates, salicylates, etc.), acute allergic reactions (anaphylactic shock).

In obstetrics and gynecology, pulmonary edema is most often associated with the development of eclampsia in pregnancy and ovarian hyperstimulation syndrome. It is possible to develop pulmonary edema against the background of prolonged mechanical ventilation with high concentrations of oxygen, uncontrolled intravenous infusion of solutions, thoracentesis with rapid simultaneous evacuation of fluid from the pleural cavity.

Pathogenesis

The main mechanisms for the development of pulmonary edema include a sharp increase in hydrostatic and decrease in oncotic (colloid-osmotic) pressure in the pulmonary capillaries, as well as a violation of the permeability of the alveolar capillary membrane.

The initial stage of pulmonary edema consists of increased filtration of transudate into the interstitial lung tissue, which is not balanced by the reabsorption of fluid into the vascular bed. These processes correspond to the interstitial phase of pulmonary edema, which clinically manifests itself as cardiac asthma.

Further movement of protein transudate and pulmonary surfactant into the lumen of the alveoli, where they mix with air, is accompanied by the formation of persistent foam, which prevents the flow of oxygen to the alveolar-capillary membrane, where gas exchange occurs. These disorders characterize the alveolar stage of pulmonary edema. The shortness of breath resulting from hypoxemia helps to reduce intrathoracic pressure, which in turn increases blood flow to the right side of the heart. In this case, the pressure in the pulmonary circulation increases even more, and the leakage of transudate into the alveoli increases. Thus, a vicious circle mechanism is formed, causing the progression of pulmonary edema.

Classification

Taking into account the trigger mechanisms, cardiogenic (heart), non-cardiogenic (respiratory distress syndrome) and mixed pulmonary edema are distinguished. The term non-cardiogenic pulmonary edema combines various cases not associated with cardiovascular diseases: nephrogenic, toxic, allergic, neurogenic and other forms of pulmonary edema.

Depending on the course, the following types of pulmonary edema are distinguished:

• fulminant– develops rapidly, within a few minutes; always ending in death
• spicy– increases quickly, up to 4 hours; Even with immediate resuscitation measures, it is not always possible to avoid death. Acute pulmonary edema usually develops with myocardial infarction, head injury, anaphylaxis, etc.
• subacute– has a wave-like flow; Symptoms develop gradually, sometimes increasing and sometimes subsiding. This variant of the course of pulmonary edema is observed with endogenous intoxication of various origins (uremia, liver failure, etc.)
• protracted– develops in the period from 12 hours to several days; may proceed smoothly, without characteristic clinical signs. Prolonged pulmonary edema occurs in chronic lung diseases and chronic heart failure.

Symptoms of pulmonary edema

Pulmonary edema does not always develop suddenly and rapidly. In some cases, it is preceded by prodromal signs, including weakness, dizziness and headache, chest tightness, tachypnea, dry cough. These symptoms may occur minutes or hours before pulmonary edema develops.

The clinical picture of cardiac asthma (interstitial pulmonary edema) can develop at any time of the day, but more often it occurs at night or in the early morning hours. An attack of cardiac asthma can be provoked by physical activity, psycho-emotional stress, hypothermia, disturbing dreams, transition to a horizontal position, and other factors. In this case, sudden suffocation or paroxysmal cough occurs, forcing the patient to sit down. Interstitial pulmonary edema is accompanied by the appearance of cyanosis of the lips and nails, cold sweat, exophthalmos, agitation and motor restlessness. Objectively, a RR of 40-60 per minute, tachycardia, increased blood pressure, and participation of auxiliary muscles in the act of breathing are detected. Breathing is increased, stridorous; On auscultation, dry wheezing may be heard; There are no moist rales.

At the stage of alveolar pulmonary edema, severe respiratory failure, severe shortness of breath, diffuse cyanosis, puffiness of the face, and swelling of the neck veins develop. In the distance, bubbling breathing can be heard; Auscultation reveals moist rales of various sizes. When breathing and coughing, foam is released from the patient's mouth, often having a pinkish tint due to the sweating of blood cells.

With pulmonary edema, lethargy, confusion, and even coma quickly increase. In the terminal stage of pulmonary edema, blood pressure decreases, breathing becomes shallow and periodic (Cheyne-Stokes breathing), and the pulse becomes thready. The death of a patient with pulmonary edema occurs due to asphyxia.

Diagnostics

In addition to assessing physical data, laboratory and instrumental studies are extremely important in the diagnosis of pulmonary edema. All studies are performed as quickly as possible, sometimes in parallel with emergency care:

1. Blood gas study. Pulmonary edema is characterized by certain dynamics: at the initial stage there is moderate hypocapnia; then, as pulmonary edema progresses, PaO2 and PaCO2 decrease; at the late stage there is an increase in PaCO2 and a decrease in PaO2. Blood CBS indicators indicate respiratory alkalosis. Measurement of central venous pressure during pulmonary edema shows its increase to 12 cm of water. Art. and more.
2. Biochemical screening. In order to differentiate the causes that led to pulmonary edema, a biochemical study of blood parameters (CPK-MB, cardiac-specific troponins, urea, total protein and albumin, creatinine, liver tests, coagulogram, etc.) is carried out.
3. ECG and EchoCG. An electrocardiogram with pulmonary edema often reveals signs of left ventricular hypertrophy, myocardial ischemia, and various arrhythmias. According to cardiac ultrasound, zones of myocardial hypokinesia are visualized, indicating a decrease in left ventricular contractility; ejection fraction is reduced, end-diastolic volume is increased.
4. X-ray of the chest organs. Reveals expansion of the borders of the heart and roots of the lungs. With alveolar pulmonary edema in the central parts of the lungs, a homogeneous symmetrical darkening in the shape of a butterfly is detected; less often - focal changes. Moderate to large pleural effusion may be present.
5. Pulmonary artery catheterization. Allows for differential diagnosis between non-cardiogenic and cardiogenic pulmonary edema.

Treatment of pulmonary edema

Treatment of pulmonary edema is carried out in the ICU under constant monitoring of oxygenation and hemodynamics. Emergency measures in the event of pulmonary edema include:

• giving the patient a sitting or half-sitting position (with the head of the bed raised), applying tourniquets or cuffs to the limbs, hot foot baths, bloodletting, which helps reduce venous return to the heart.
• It is more expedient to supply humidified oxygen during pulmonary edema through antifoam agents - antifomsilan, ethyl alcohol.
• if necessary, transfer to mechanical ventilation. If there are indications (for example, to remove a foreign body or aspiration of contents from the respiratory tract), tracheostomy is performed.
• administration of narcotic analgesics (morphine) to suppress the activity of the respiratory center.
• administration of diuretics (furosemide, etc.) to reduce blood volume and dehydration of the lungs.
• administration of sodium nitroprusside or nitroglycerin to reduce afterload.
• the use of ganglion blockers (azamethonium bromide, trimethaphan) can quickly reduce pressure in the pulmonary circulation.

According to indications, patients with pulmonary edema are prescribed cardiac glycosides, antihypertensive, antiarrhythmic, thrombolytic, hormonal, antibacterial, antihistamine drugs, infusions of protein and colloid solutions. After stopping the attack of pulmonary edema, treatment of the underlying disease is carried out.

Prognosis and prevention

Regardless of the etiology, the prognosis for pulmonary edema is always extremely serious. In acute alveolar pulmonary edema, mortality reaches 20-50%; if edema occurs against the background of myocardial infarction or anaphylactic shock, the mortality rate exceeds 90%. Even after successful relief of pulmonary edema, complications are possible in the form of ischemic damage to internal organs, congestive pneumonia, pulmonary atelectasis, and pneumosclerosis. If the root cause of pulmonary edema is not eliminated, there is a high probability of its recurrence.

A favorable outcome is greatly facilitated by early pathogenetic therapy undertaken in the interstitial phase of pulmonary edema, timely detection of the underlying disease and its targeted treatment under the guidance of a specialist in the appropriate profile (pulmonologist, cardiologist, infectious disease specialist, pediatrician, neurologist, otolaryngologist, nephrologist, gastroenterologist, etc.) .

The lungs are an organ that takes part in supplying oxygen to the body and removing waste products of metabolism, in particular carbon dioxide. The main structural unit in this case is the pulmonary alveolus (vesicle), consisting of a semi-permeable membrane and surrounded by tiny blood vessels - capillaries. When air enters the bronchi and alveoli during inhalation, oxygen molecules overcome the membrane and end up in the blood, where they bind to red blood cells. Oxygen is then transported to all cells in the body. During exhalation, carbon dioxide from red blood cells penetrates into the lumen of the alveoli and is removed with the exhaled air.

If respiratory function is impaired, all internal organs, and primarily the brain, suffer from oxygen deficiency and excess carbon dioxide in the blood. With pulmonary edema, these disorders develop quite quickly, so it can cause brain hypoxia and clinical death.

Penetration of the liquid part of the blood into the lungs from the blood vessels occurs due to high pressure in the vessels of the lungs or due to direct damage to the pulmonary membrane. In the first case, the liquid sweats through the vascular wall, and in the second it penetrates the alveoli as a result of a violation of the anatomical barrier between the capillaries and the lung tissue.

More often, edema of the pulmonary tissue occurs in patients over 40 years of age due to the greater prevalence of cardiac pathology in this population, but it also develops in children and adults. The prevalence of this pathology increases sharply after 65 years.

Causes of the disease

Depending on the condition that led to pathophysiological disorders in the lungs, cardiogenic, or cardiac, and non-cardiogenic variants are distinguished.

Cardiac pulmonary edema(acute left ventricular failure), can complicate the course of diseases such as:

• Acute myocardial infarction is the cause of pulmonary edema in 60% of cases.
• Chronic heart failure - 9%.
• Acutely occurring cardiac arrhythmia – in 6%.
• Heart defects (acquired and congenital) - 3%.

Non-cardiogenic pulmonary edema occurs in 10% of all emergency conditions and is caused by any of the following reasons:

The development of non-cardiogenic pulmonary edema occurs through several mechanisms at once - a damaging effect on the capillary-alveolar membrane of toxic agents, an increase in blood volume with significant intravenous fluid intake, protein metabolism disorders in diseases of internal organs, dysfunction of the cardiovascular system, disturbances in the nervous regulation of external respiration function for diseases of the central nervous system.

Unfortunately, not only people, but also pets are susceptible to this condition. The most common causes of pulmonary edema in cats and dogs are distemper, inhalation of hot air, overheating of the body and heat stroke, pneumonia, and poisoning by poisonous gases.

Symptoms of the disease

With a cardiogenic nature, an increase in symptoms is possible within a few days before the appearance of pronounced signs of pulmonary edema. The patient is bothered by episodes of cardiac asthma at night - shortness of breath (respiratory rate 30 per minute or more), obsessiveness and difficulty in inhaling. These are signs of interstitial edema, in which the liquid part of the blood accumulates in the lung tissue, but does not yet penetrate the alveoli.

The general condition is severe - severe weakness, cold sweat, severe pallor and coldness of the extremities are noted; with further development, the bluish color of the skin quickly increases - cyanosis. Blood pressure decreases, pulse is frequent and weak. The patient experiences severe fear and anxiety, and breathing is only possible in a sitting position with emphasis on the arms (orthopnea).

Another variant of the development of edema is also possible, when, against the background of complete health, an already existing, asymptomatic heart disease debuts with the symptoms described above. For example, this option occurs when asymptomatic myocardial ischemia leads to the development of a heart attack with acute left ventricular failure.

Non-cardiogenic pulmonary edema is clinically manifested by similar signs that suddenly develop, for example, after inhaling a toxic substance, against the background of a high fever or during pneumonia.

In children the initial signs of pulmonary edema are sometimes difficult to suspect if it is caused by bronchitis or pneumonia, due to the fact that the symptoms of the underlying disease also include coughing, wheezing and increased breathing. In this case, parents should be alerted to such signs as sudden severe shortness of breath, sudden cyanosis of the skin of the face or limbs, bubbling breathing and the appearance of foamy sputum.

In some patients with cardiac pathology, left ventricular failure may develop several times, then it is called recurrent or chronic pulmonary edema. After successful relief of the previous edema in a hospital setting, after some time the patient again develops signs of cardiac asthma, which, in the absence of correction of the treatment, turns into alveolar pulmonary edema. This option is prognostically unfavorable.

Diagnosis of the disease

The diagnosis can be suspected even at the stage of examining the patient based on the following signs:

• Typical complaints
• General serious condition
• Retraction of intercostal spaces during breathing,
• Swelling of the neck veins,
• Increased humidity, pallor and cyanosis of the skin.

Additional methods are used to confirm the diagnosis:

In the emergency department of a hospital, where a patient with pulmonary edema is delivered, an ECG and X-ray are sufficient, since it is important to transport the patient to the intensive care unit as quickly as possible, without wasting time on examination. As the patient recovers from a serious condition, other diagnostic methods are prescribed.

At the prehospital stage It is important to distinguish pulmonary edema from bronchial asthma. The main differences are reflected in the table:

Signs	Bronchial asthma	Pulmonary edema
Dyspnea	Exhalation lengthened	Inhalation lengthened
Breath	Wheezing wheezes	Wet wheezing
Sputum	Scanty, viscous, glassy	Abundant, pink, foamy character
Medical history	History: episodes of bronchial asthma, allergic diseases	History of cardiac disease
ECG signs	Right ventricular overload	Left ventricular overload

Treatment

Emergency assistance should be provided immediately as soon as others notice signs of swelling in the patient. The algorithm of actions boils down to the following activities:

• Calm the patient, give him a semi-sitting position, lower his legs down,
• Measure blood pressure and heart rate,
• Call an ambulance, describing in detail to the dispatcher the dangerous symptoms,
• Open the window for fresh air,
• Reassure and explain to the patient that panic will worsen his condition,
• If blood pressure is within normal limits (110-120/70-80 mm Hg), take a nitroglycerin tablet under the tongue; if the pressure is lower, it is not recommended to take nitroglycerin.
• Place the patient's legs in a basin of hot water to reduce venous return to the heart,
• If signs of clinical death appear (lack of consciousness, breathing and pulse in the carotid artery), begin chest compressions and artificial respiration with a ratio of 15:2 until the medical team arrives.

The actions of the emergency doctor are as follows:

1. Taking and interpreting ECG,
2. Supply of humidified oxygen through a mask, passed through a 96% ethyl alcohol solution to reduce foaming,
3. Administration of diuretics intravenously (furosemide), nitroglycerin (if blood pressure is reduced, then in combination with drugs that maintain its level - dopamine, dobutamine),
4. The use of medications depending on the underlying disease - morphine or promedol for acute infarction, antiallergic drugs (diphenhydramine, pipolfen, suprastin, prednisolone) for the allergic nature of the disease, glycosides (strophanthin, korglykon) for atrial fibrillation and other rhythm disturbances,
5. Immediate transportation to a specialized hospital.

Inpatient treatment is carried out in the intensive care unit. To relieve pulmonary edema, intravenous infusions of nitroglycerin, diuretics, and detoxification therapy are prescribed for the toxic nature of the disease. For diseases of internal organs, appropriate treatment is indicated, for example, antibiotic therapy for purulent-septic processes, bronchitis, pneumonia, hemodialysis for renal failure, etc.

Prevention of pulmonary edema

Patients after cardiogenic pulmonary edema, the underlying disease that led to such a dangerous condition should be treated. To do this, you must constantly take medications as prescribed by your doctor, for example, ACE inhibitors (enalapril, lisinopril, Prestarium, etc.) and beta-blockers (propranolol, metoprolol, etc.). It has been reliably proven that these drugs significantly reduce the risk of complications and sudden death from heart disease. In addition to drug treatment, it is recommended to follow a diet with a reduction in salt content in food to 5 mg per day and with the volume of liquids consumed up to 2 liters per day.

If the disease is non-cardiogenic, preventing re-edema comes down to treating diseases of the internal organs, preventing infectious diseases, careful use of toxic drugs, timely detection and treatment of allergic conditions, and avoiding contact with toxic chemicals.

Forecast

The prognosis for delays in seeking medical help is unfavorable, since respiratory failure leads to death.

The prognosis for emergency care provided on time is favorable, but for recurrent pulmonary edema it is questionable.

Video: pulmonary edema - when it occurs, diagnosis, clinic

Pulmonary edema is a pathological condition that is caused by the leakage of non-inflammatory fluid from the pulmonary capillaries into the interstitium of the lungs and alveoli, leading to a sharp disruption of gas exchange in the lungs and the development of oxygen starvation of organs and tissues - hypoxia. Clinically, this condition is manifested by a sudden feeling of lack of air (suffocation) and cyanosis (cyanosis) of the skin. Depending on the causes that caused it, pulmonary edema is divided into 2 types:

• membranous (develops when the body is exposed to exogenous or endogenous toxins that violate the integrity of the vascular wall and alveolar wall, resulting in fluid from the capillaries entering the lungs);
• hydrostatic (develops against the background of diseases that cause an increase in hydrostatic pressure inside the vessels, which leads to the release of blood plasma from the vessels into the interstitial space of the lungs, and then into the alveoli).

Causes and mechanisms of development of pulmonary edema

Pulmonary edema is characterized by the presence of non-inflammatory fluid in the alveoli. This disrupts gas exchange, leading to hypoxia of organs and tissues.

Pulmonary edema is not an independent disease, but a condition that is a complication of other pathological processes in the body.

Pulmonary edema can be caused by:

• diseases accompanied by the release of endogenous or exogenous toxins (infection entering the bloodstream (sepsis), pneumonia (pneumonia), drug overdose (Fentanyl, Apressin), radiation damage to the lungs, taking drugs - heroin, cocaine; toxins violate the integrity of the alveolar capillary membrane, as a result, its permeability increases, and fluid from the capillaries exits into the extravascular space;
• heart disease in the stage of decompensation, accompanied by left ventricular failure and stagnation of blood in the pulmonary circulation (heart defects);
• pulmonary diseases leading to stagnation in the right circulation (bronchial asthma, emphysema);
• pulmonary embolism (in persons predisposed to thrombus formation (suffering from hypertension, etc.), a blood clot may form, followed by its separation from the vascular wall and migration with the bloodstream throughout the body; reaching the branches of the pulmonary artery, the thrombus can clog its lumen, which will cause an increase in pressure in this vessel and the capillaries branching from it - hydrostatic pressure increases in them, which leads to pulmonary edema);
• diseases accompanied by a decrease in protein content in the blood (liver cirrhosis, kidney pathology with nephrotic syndrome, etc.); in the above conditions, the oncotic pressure of the blood decreases, which can cause pulmonary edema;
• intravenous infusions (infusions) of large volumes of solutions without subsequent forced diuresis lead to an increase in hydrostatic blood pressure and the development of pulmonary edema.

Signs of pulmonary edema

Symptoms appear suddenly and increase rapidly. The clinical picture of the disease depends on how quickly the interstitial stage of edema transforms into the alveolar stage.

Based on the rate of progression of symptoms, the following forms of pulmonary edema are distinguished:

• acute (signs of alveolar edema appear 2–4 hours after the appearance of signs of interstitial edema) – occurs with mitral valve defects (usually after psycho-emotional stress or excessive physical exertion), myocardial infarction;
• subacute (lasts from 4 to 12 hours) – develops due to fluid retention in the body, with acute hepatic or congenital heart defects and great vessels, lesions of the lung parenchyma of a toxic or infectious nature;
• prolonged (lasting 24 hours or more) - occurs in chronic renal failure, chronic inflammatory lung diseases, systemic connective tissue diseases (vasculitis);
• fulminant (a few minutes after the onset of edema leads to death) - observed in anaphylactic shock, extensive myocardial infarction.

In chronic diseases, pulmonary edema usually begins at night, which is associated with the patient being in a horizontal position for a long time. In the case of pulmonary embolism, the development of events at night is not at all necessary - the patient’s condition can worsen at any time of the day.

The main signs of pulmonary edema are:

• intense shortness of breath at rest; breathing is frequent, shallow, bubbling, it can be heard from a distance;
• a sudden feeling of a sharp lack of air (attacks of painful suffocation), intensifying when the patient lies on his back; such a patient takes the so-called forced position - orthopnea - sitting with the torso bent forward and supported by outstretched arms;
• pressing, squeezing pain in the chest caused by lack of oxygen;
• severe tachycardia (rapid heartbeat);
• cough with distant wheezing (audible at a distance), discharge of pink foamy sputum;
• pallor or blue discoloration (cyanosis) of the skin, profuse sticky sweat - the result of centralization of blood circulation in order to provide oxygen to vital organs;
• agitation of the patient, fear of death, confusion or complete loss of consciousness - coma.

Diagnosis of pulmonary edema

A chest x-ray will help confirm the diagnosis.

If the patient is conscious, the doctor’s primary concern is his complaints and medical history - he conducts a detailed questioning of the patient in order to establish the possible cause of pulmonary edema. In the case where the patient is not available for contact, a thorough objective examination of the patient comes to the fore, allowing one to suspect edema and suggest the reasons that could lead to this condition.

When examining a patient, the doctor’s attention will be drawn to pallor or cyanosis of the skin, swollen, pulsating veins of the neck (jugular veins) as a result of stagnation of blood in the pulmonary circulation, rapid or shallow breathing of the patient.

Cold sticky sweat may be noted by palpation, as well as an increase in the patient’s pulse rate and its pathological characteristics - it is weakly filled, thread-like.

When percussing (tapping) the chest, a dullness of the percussion sound over the lung area will be noted (confirms that the lung tissue has an increased density).

Auscultation (listening to the lungs using a phonendoscope) reveals hard breathing and a mass of moist, large-bubble rales, first in the basal, then in all other parts of the lungs.

Blood pressure is often elevated.

Of the laboratory research methods for diagnosing pulmonary edema, the following are important:

• a general blood test will confirm the presence of an infectious process in the body (characterized by leukocytosis (an increase in the number of leukocytes), with a bacterial infection an increase in the level of band neutrophils, or rods, an increase in ESR).
• biochemical blood test - allows you to differentiate “cardiac” causes of pulmonary edema from causes caused by hypoproteinemia (decreased protein levels in the blood). If the cause of edema is myocardial infarction, the level of troponins and creatine phosphokinase (CPK) will be increased. A decrease in the level of total protein and albumin in the blood in particular is a sign that the edema is caused by a disease accompanied by hypoproteinemia. An increase in urea and creatinine levels indicates the renal nature of pulmonary edema.
• coagulogram (blood's ability to clot) - will confirm pulmonary edema resulting from pulmonary embolism; diagnostic criterion is an increase in the level of fibrinogen and prothrombin in the blood.
• determination of blood gas composition.

The patient may be prescribed the following instrumental examination methods:

• pulse oximetry (determines the degree of oxygen saturation in the blood) - in case of pulmonary edema, its percentage will be reduced to 90% or less;
• determination of central venous pressure (CVP) values ​​is carried out using a special device - a Waldman phlebotonometer connected to the subclavian vein; with pulmonary edema, CVP is increased;
• electrocardiography (ECG) – determines cardiac pathology (signs of ischemia of the heart muscle, its necrosis, arrhythmia, thickening of the walls of the heart chambers);
• echocardiography (ultrasound of the heart) - to clarify the nature of the changes detected on the ECG or auscultation; thickening of the walls of the heart chambers, decreased ejection fraction, valve pathology, etc. can be determined;
• X-ray of the chest organs - confirms or refutes the presence of fluid in the lungs (darkening of the lung fields on one or both sides); in case of cardiac pathology - an increase in the size of the heart shadow.

Treatment of pulmonary edema

Pulmonary edema is a life-threatening condition for the patient, so at the first symptoms you must immediately call an ambulance.

During transportation to the hospital, emergency medical personnel carry out the following treatment measures:

• the patient is placed in a semi-sitting position;
• oxygen therapy with an oxygen mask or, if necessary, tracheal intubation and artificial ventilation;
• nitroglycerin tablet sublingually (under the tongue);
• intravenous administration of narcotic analgesics (morphine) - for the purpose of pain relief;
• diuretics (Lasix) intravenously;
• to reduce blood flow to the right side of the heart and prevent an increase in pressure in the pulmonary circulation, venous tourniquets are applied to the upper third of the patient’s thighs (preventing the disappearance of the pulse) for up to 20 minutes; remove the tourniquets, gradually loosening them.

Further treatment measures are carried out by specialists from the intensive care unit, where strict continuous monitoring of hemodynamic parameters (pulse and pressure) and breathing is carried out. Medicines are usually administered through the subclavian vein, into which a catheter is inserted.

For pulmonary edema, the following groups of drugs can be used:

• to extinguish foam that forms in the lungs - so-called defoamers (oxygen inhalation + ethyl alcohol);
• with high blood pressure and signs of myocardial ischemia - nitrates, in particular nitroglycerin;
• to remove excess fluid from the body - diuretics, or diuretics (Lasix);
• for low blood pressure - drugs that increase heart contractions (Dopamine or Dobutamine);
• for pain - narcotic analgesics (morphine);
• for signs of pulmonary embolism, drugs that prevent excessive blood clotting or anticoagulants (Heparin, Fraxiparin);
• for slow heart contractions - Atropine;
• for signs of bronchospasm - steroid hormones (Prednisolone);
• for infections - broad-spectrum antibacterial drugs (carbopenems, fluoroquinolones);
• for hypoproteinemia - infusion of fresh frozen plasma.

Prevention of pulmonary edema

A patient with pulmonary edema is hospitalized in the intensive care unit.

Timely diagnosis and adequate treatment of diseases that can provoke it will help prevent the development of pulmonary edema.

Pulmonary edema is a disease that is characterized by pulmonary failure, presented in the form of mass waste transudate from the capillaries into the pulmonary region, resulting in infiltration of the alveoli. In simple words, pulmonary edema is a process in which fluid seeps through the blood vessels and stagnates in the lungs. The disease can be independent, or it can be a consequence of other serious ailments of the body.

The lungs are an organ that consists of alveoli filled with a large number of capillaries. The process of gas exchange occurs in this organ, as a result of which the body is filled with oxygen, which ensures good performance of the body. If in the alveolus liquid penetrates, not oxygen– this contributes to the formation of pulmonary edema.

Important . Pulmonary edema is a dangerous disease that can have such dangerous consequences as death. The disease affects both adults and children.

Prognosis and complications of the disease

Often the prognosis for pulmonary edema is unfavorable. This is due to the reasons that caused the disease. Non-cardiogenic edema is easy to treat, while cardiogenic edema is very difficult to treat. Even with effective treatment for cardiogenic edema, survival is only 50%. If the form is lightning, then the person cannot be saved. Toxic edema is a serious diagnosis and a favorable outcome is only possible with the use of large amounts of diuretics. It all depends on the individual characteristics of the body.

The consequences of pulmonary edema can be very diverse. Often, internal organs are damaged. The most pronounced changes occur in tissues that are more supplied with oxygen - lungs, heart, brain, liver, kidneys, adrenal glands. Disturbances in the functioning of these organs can cause heart failure. and even result in death. In addition, the following respiratory diseases occur:

• Congestive pneumonia
• Pulmonary atelectasis
• Emphysema
• Pneumosclerosis.

Causes of pulmonary edema

The causes of pulmonary edema are very different, but they need to be known, since the consequences of the disease are very serious, even fatal. Most often, pulmonary edema manifests itself as a complication of some disease. The main causes of pulmonary edema include:

• Acute intoxication of the body. It manifests itself as a result of toxic elements entering the body, both non-infectious and infectious. Toxic elements have adverse effects on alveolar membranes. Intoxication of the body includes: excess medications, bacterial pneumonia, poisoning with drugs or poison.
• General malaise of the left ventricle. As a result of this disease, pathological abnormalities of the cardiovascular system appear (heart disease, myocardial infarction, angina pectoris, arterial hypertension). Pulmonary edema may occur as a result of these diseases.
• Chronic pulmonary disease. Among these are bronchial asthma, emphysema, pneumonia, and malignant tumors of the lung cavity.
• Significant physical activity. For example, an athlete who climbs a mountain may experience pulmonary edema. It often occurs in female athletes rather than in males.
• TELA. Pulmonary edema can occur due to blockage of the pulmonary arteries by blood clots. This can be fatal.
• When oncotic pressure decreases. When pressure decreases, the amount of protein in the blood decreases, resulting in diseases such as liver cirrhosis and chronic hemorrhagic syndrome.
• Long-term use of medications, especially intravenous drugs, if renal excretory function is impaired.
• Severe head injuries
• With long-term artificial ventilation
• When vomit enters the respiratory organs. Often, this is observed in newborn children with incorrect posture during sleep.
• In case of drowning
• When various substances enter the respiratory tract.

Pulmonary edema may be cardiogenic and non-cardiogenic. Cardiogenic pulmonary edema occurs as a result of left heart failure. Insufficiency occurs for the following reasons:

• Ventricular pathology – heart disease, myocardial infarction, myocarditis, cardiosclerosis.
• Pathological abnormalities of the atrium.

Important . Non-cardiogenic edema occurs as a result of drug overuse.

Symptoms of pulmonary edema

Symptoms of the disease arise suddenly often at night (due to the patient’s supine position):

• Attacks of painful, severe suffocation are intensified in a supine position, so the patient sits or stands. This is due to a lack of oxygen.
• Shortness of breath occurs even at rest
• Pain in the chest due to insufficient oxygen.
• A sharp increase in breathing (due to stimulation of the respiratory center by carbon dioxide that has not been released).
• Palpitations
• Cough with pink sputum
• The patient's face has a gray-bluish tint, and after a while it affects all parts of the body. This is due to changes in the release of carbon dioxide from the blood.
• Pale skin and cold, clammy sweat
• Veins in the neck area swell due to stagnation in the pulmonary circulation
• Blood pressure increases
• Patient's confusion
• Thready, weak pulse

Diagnostics

In addition to a visual examination of the patient admitted with the first symptoms of pulmonary edema, the specialist must conduct instrumental and laboratory research, to confirm the accuracy of the diagnosis. Diagnostics involves the following procedures:

1. Carrying out blood gas studies.
2. Biochemical blood test.
3. Electrocardiogram
4. Ultrasound of the heart
5. Breast X-ray.

The results of the procedures will allow us to determine not only the treatment regimen, but also the cause of the disease.

Pulmonary edema in children

Pulmonary edema in children most often manifests itself as a result of pathology of the cardiovascular system. This may be an allergic reaction or due to inhalation of toxic components. Swelling can occur at any time, but most often occurs at night. The baby is worried and even frightened by a significant lack of air. Among the main symptoms of pulmonary edema in children are:

• Cough
• Dyspnea
• Foamy pink sputum
• Wheezing
• Blueness of the skin

In newborn babies, pulmonary edema can occur due to the following pathologies:

• Placental infarction is the death of cells in a separate area of ​​the placenta. As a result, blood flows poorly to the fetus and hypoxia may occur.
• Aspiration of amniotic fluid is penetration of amniotic fluid into the lower respiratory tract.
• Prenatal or birth brain injury.
• Heart defects.

First aid for pulmonary edema

Before the ambulance arrives, you can do the following on your own:

• Sit the patient so that the legs are down
• Provide rapid access to a large peripheral vein
• Organize then fresh air
• Organize a hot foot bath
• Allow the patient to inhale alcohol vapor
• Track breathing and pulse
• Apply venous tourniquets to the extremities
• If the pressure is not reduced, you can take 1-2 tablets of nitroglycerin under the tongue.

Algorithm for the treatment of pulmonary edema

Therapy for pulmonary edema consists of 7 stages:

1. Sedative therapy
2. Defoaming
3. Vasodilator therapy
4. Diuretics
5. Cardiac glycosides and glucocorticoids
6. Blood exfusion
7. Hospitalization of the patient.

Basic therapy includes:

• For liver cirrhosis, a course of hepatoprotectors is prescribed
• In case of pancreatic necrosis, drugs are initially prescribed that inhibit the functioning of the pancreas, and then drugs that stimulate the healing of necrosis.
• Comprehensive treatment of myocardial infarction
• For bronchopulmonary diseases, a course of antibiotics is required.
• In case of toxic edema, detoxification therapy is necessary. Salt mixtures help replenish fluid that was lost due to the use of diuretics.
• For asthma - expectorants, mucolytics, bronchodilators.
• For toxic shock - antihistamines
• Edema of any form requires the use of potent antibiotics and antiviral drugs.

The duration of therapy for pulmonary edema depends on the form of the disease, concomitant diseases, general condition and age of the patient. Often times can vary from 1 to 4 weeks.

Additional information. If the swelling proceeds without any complications and with effective therapy, the treatment period is no more than 10 days.

Possible consequences after emergency care:

1. Transition to lightning-fast degree of edema
2. Due to the rapid production of foam, airway obstruction occurs
3. Respiratory depression
4. Tachyarrhythmia
5. Asystole
6. Angious pain. The pain is so severe that the patient may go into painful shock.
7. Inability to normalize blood pressure. Often, pulmonary edema occurs with low or high blood pressure, which can alternate. The vessels cannot withstand these changes for a long period, as a result of which the patient’s condition worsens significantly.
8. Pulmonary edema increases as a result of increased blood pressure.

Prevention

Prevention is based on early identification of the disease causing pulmonary edema. Patients suffering from chronic deficiency should follow a diet that is based on: limiting the amount of salt and fluid consumed, avoiding fatty foods and reducing physical activity. As a result of the presence of chronic pulmonary diseases, one should constantly consult with a specialist, carry out therapy on an outpatient basis, twice a year treat in a hospital, and prevent factors that could worsen the patient’s condition (interaction with allergens, acute respiratory diseases, smoking cessation).