Pulmonary edema - symptoms, causes and treatment of pulmonary edema. Emergency care for pulmonary edema

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Pulmonary edema - symptoms, causes and treatment of pulmonary edema. Emergency care for pulmonary edema
Pulmonary edema - symptoms, causes and treatment of pulmonary edema. Emergency care for pulmonary edema
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What is pulmonary edema?

Pulmonary edema is a serious pathological condition associated with a massive release of non-inflammatory transudate from the capillaries into the interstitium of the lungs, then into the alveoli. The process leads to a decrease in the functions of the alveoli and a violation of gas exchange, hypoxia develops. The gas composition of the blood changes significantly, the concentration of carbon dioxide increases. Along with hypoxia, severe depression of the functions of the central nervous system occurs. Exceeding the normal (physiological) level of interstitial fluid leads to edema.

The interstitium contains: lymphatic vessels, connective tissue elements, intercellular fluid, blood vessels. The entire system is covered by the visceral pleura. The branched hollow tubules and tubes are the complex that makes up the lungs. The entire complex is immersed in the interstitium. The interstitium is formed by plasma leaving the blood vessels. The plasma is then reabsorbed back into the lymphatic vessels that empty into the vena cava. According to this mechanism, the intercellular fluid delivers oxygen and necessary nutrients to the cells, removes metabolic products.

Violation of the amount and outflow of interstitial fluid leads to pulmonary edema:

  • when an increase in hydrostatic pressure in the blood vessels of the lungs causes an increase in interstitial fluid, hydrostatic edema occurs;
  • the increase was due to excessive plasma filtration (for example: with the activity of inflammatory mediators), membrane edema occurs.
pulmonary edema
pulmonary edema

Status assessment

Depending on the rate of transition of the interstitial stage of edema to the alveolar stage, the patient's condition is assessed. In the case of chronic diseases, edema develops more gradually, more often at night. Such edema is well stopped by drugs. Edema associated with mitral valve defects, myocardial infarction, lung parenchyma damage is growing rapidly. The condition is rapidly deteriorating. Acute edema leaves very little time to react.

Disease prognosis

Prognosis of pulmonary edema is unfavorable. It depends on the reasons that actually caused the edema. If the edema is non-cardiogenic, it responds well to treatment. Cardiogenic edema is difficult to stop. After prolonged treatment after cardiogenic edema, the survival rate for a year is 50%. With a lightning-fast form, it is often impossible to save a person.

With toxic edema, the prognosis is very serious. Favorable prognosis when taking large doses of diuretics. Depends on the individual reaction of the organism.

Diagnosis

The picture of any type of pulmonary edema is bright. Therefore, the diagnosis is simple. For adequate therapy, it is necessary to determine the causes that caused the edema. Symptoms depend on the form of edema. The lightning-fast form is characterized by rapidly increasing suffocation and respiratory arrest. The acute form has more pronounced symptoms, in contrast to the subacute and protracted.

Symptoms of pulmonary edema

Symptoms of pulmonary edema
Symptoms of pulmonary edema

The main symptoms of pulmonary edema include:

  • frequent coughing;
  • growing hoarseness;
  • cyanosis (face and mucous membranes become bluish);
  • growing suffocation;
  • chest tightness, pressing pain;
  • breathing;
  • dizziness, weakness;
  • gurgling rales are heard;
  • with growing cough - frothy pink sputum;
  • when the condition worsens, sputum comes out of the nose;
  • the person is frightened, the mind can be confused;
  • sweating, sweat cold and clammy;
  • fear of death;
  • increased heart rate up to 200 beats per minute. May easily progress to life-threatening bradycardia;
  • fall or spike in blood pressure.

Pulmonary edema itself is a disease that does not occur on its own. Many pathologies can lead to edema, sometimes not at all associated with diseases of the bronchopulmonary and other systems.

Causes of pulmonary edema

Causes of pulmonary edema
Causes of pulmonary edema

Causes of pulmonary edema include:

  1. Sepsis. Usually is the penetration into the bloodstream of exogenous or endogenous toxins;
  2. Pneumonia;
  3. Overdose of certain (NSAIDs, cytostatics) drugs;
  4. Radiation damage to the lungs;
  5. Drug overdose;
  6. Myocardial infarction, heart disease, ischemia, hypertension, any heart disease in the stage of decompensation;
  7. Stagnation in the right circulatory system that occurs with bronchial asthma, emphysema and other lung diseases;
  8. A sharp or chronic decrease in protein in the blood. Hypoalbuminemia occurs with cirrhosis of the liver, nephrotic syndrome and other kidney pathologies;
  9. Large volume infusions without forced diuresis;
  10. Toxic gas poisoning;
  11. Poisons;
  12. Gastric aspiration;
  13. Shock for serious injuries;
  14. Enteropathy;
  15. Being at high altitude;
  16. Acute hemorrhagic pancreatitis.

Types of pulmonary edema

Types of pulmonary edema
Types of pulmonary edema

There are two types of pulmonary edema: cardiogenic and non-cardiogenic. There is also a group 3 pulmonary edema (refers to non-cardiogenic) - toxic edema.

Cardiogenic edema (cardiac edema)

Cardiogenic edema is always caused by acute left ventricular failure, obligatory stagnation of blood in the lungs. Myocardial infarction, heart defects, angina pectoris, arterial hypertension, left ventricular failure are the main causes of cardiogenic edema. To link pulmonary edema with chronic or acute heart failure, lung capillary pressure is measured. In the case of a cardiogenic type of edema, the pressure rises above 30 mm Hg. Art. Cardiogenic edema provokes extravasation of fluid into the interstitial space, further into the alveoli. Attacks of interstitial edema are observed at night (paroxysmal dyspnea). The patient is out of breath. Auscultation reveals harsh breathing. Breathing is increased on exhalation. Choking is the main symptom of alveolar edema.

The following symptoms are typical for cardiogenic edema:

  • suffocation;
  • growing cough;
  • inspiratory dyspnea. The patient is characterized by a sitting position, in the prone position, shortness of breath increases;
  • tissue hyperhydration (puffiness);
  • dry whistling, turning into wet gurgling rales;
  • pink foamy sputum;
  • acrocyanosis;
  • unstable blood pressure. It's hard to bring it down. A decrease below normal can lead to bradycardia and death;
  • tachycardia;
  • severe pain behind the sternum or in the chest area;
  • fear of death;
  • On the electrocardiogram, hypertrophy of the left atrium and ventricle is read, sometimes blockade of the left leg of the bundle of His.

Hemodynamic conditions of cardiogenic edema

  • violation of left ventricular systole;
  • diastolic dysfunction;
  • systolic dysfunction.

The leading cause of cardiogenic edema is left ventricular dysfunction.

Cardiogenic edema should be differentiated from non-cardiogenic edema. With a non-cardiogenic form of edema, changes in the cardiogram are less pronounced. Cardiogenic edema proceeds more rapidly. The time for emergency care is less than with other types of edema. Lethal outcome is more often with cardiogenic edema.

Toxic pulmonary edema

Toxic pulmonary edema
Toxic pulmonary edema

Toxic edema has certain specific features that promote differentiation. There is a period here when there is no edema itself yet, there are only reflex reactions of the body to irritation. Burns of lung tissues, burns of the respiratory tract cause reflex spasm. This is a combination of symptoms of damage to the respiratory organs and the resorptive effects of toxic substances (poisons). Toxic edema can develop regardless of the dose of medication that caused it.

Drugs that can cause pulmonary edema:

  • narcotic analgesics;
  • many cytostatics;
  • diuretics;
  • X-ray contrast agents;
  • non-steroidal anti-inflammatory drugs.

Risk factors for toxic edema are older age, long-term smoking.

Has 2 forms, developed and abortive. There is a so-called "silent" edema. It can be detected on x-ray examination of the lungs. There is practically no definite clinical picture in such edema.

It is characterized by periodicity. Has 4 periods:

  1. Reflex disorders. It is characterized by symptoms of irritation of the mucous membranes: lacrimation, cough, shortness of breath. The period is dangerous by stopping breathing and cardiac activity;
  2. Latent period of subsidence of irritations. May last 4-24 hours. Characterized by clinical well-being. Careful examination may show signs of impending edema: bradycardia, emphysema;
  3. Directly pulmonary edema. The course is sometimes slow, up to 24 hours. Most often, the symptoms increase in 4-6 hours. During this period, the temperature rises, there is neutrophilic leukocytosis in the blood count, there is a danger of collapse. The developed form of toxic edema has a fourth period of completed edema. The completed period has "blue hypoxemia". Cyanosis of the skin and mucous membranes. The completed period increases the respiratory rate to 50-60 times per minute. The bubbling breath is heard in the distance, sputum mixed with blood. Increases blood clotting. gaseous acidosis develops. "Gray" hypoxemia is characterized by a more severe course. Vascular complications join. The skin takes on a pale grayish tint. The limbs get cold. Thready pulse and falling to critical values of arterial pressure. This condition is facilitated by physical activity or improper transportation of the patient;
  4. Complications. When leaving the period of direct pulmonary edema, there is a risk of developing secondary edema. It is associated with left ventricular failure. Pneumonia, pneumosclerosis, emphysema are common complications of drug-induced toxic edema. At the end of the 3rd week, a “secondary” edema may occur against the background of acute heart failure. Rarely there is an exacerbation of latent tuberculosis and other chronic diseases. Depression, drowsiness, asthenia.

With rapid and effective therapy, a period of regression of edema occurs. It does not apply to the main periods of toxic edema. It all depends on the quality of the assistance provided. Cough and shortness of breath decrease, cyanosis decreases, wheezing in the lungs disappears. On x-ray, the disappearance of large, then small foci is noticeable. The picture of peripheral blood is normalized. The recovery period after toxic edema can be several weeks.

In rare cases, toxic edema can be caused by taking tocolytics. Edema can be catalyzed by: large volumes of intravenous fluid, recent treatment with glucocorticoids, multiple pregnancy, anemia, unstable hemodynamics in a woman.

Clinical manifestations of the disease:

  • Key symptom is respiratory distress;
  • Severe shortness of breath;
  • Cough;
  • Severe chest pain;
  • Cyanosis of the skin and mucous membranes;
  • Hypotension combined with tachycardia.

From cardiogenic edema, toxic edema is distinguished by a protracted course and a small amount of protein in the fluid. The size of the heart does not change (rarely changes). Venous pressure is often within normal limits.

Diagnosis of toxic edema is not difficult. The exception is bronchorrhea in case of FOS poisoning.

Non-cardiogenic pulmonary edema

Non-cardiogenic pulmonary edema
Non-cardiogenic pulmonary edema

Occurs due to increased vascular permeability and high fluid filtration through the wall of the pulmonary capillaries. With a large amount of fluid, the work of blood vessels deteriorates. Fluid begins to fill the alveoli and gas exchange is disrupted.

Causes of non-cardiogenic edema:

  • renal artery stenosis;
  • pheochromocytoma;
  • massive renal failure, hyperalbuminemia;
  • exudative enteropathy;
  • pneumothorax can cause unilateral non-cardiogenic pulmonary edema;
  • severe asthma attack;
  • inflammatory diseases of the lungs;
  • pneumosclerosis;
  • sepsis;
  • gastric aspiration;
  • cancerous lymphangitis;
  • shock, especially in sepsis, aspiration and pancreatic necrosis;
  • cirrhosis of the liver;
  • radiation;
  • inhalation of toxic substances;
  • lung cancer;
  • large transfusions of drug solutions;
  • in elderly patients taking long-term acetylsalicylic acid preparations;
  • drug addiction.

For a clear distinction between edema, the following measures should be taken:

  • to study the patient's history;
  • apply methods of direct measurement of central hemodynamics;
  • radiography;
  • assess the affected area in case of myocardial ischemia (enzyme tests, ECG).

To differentiate non-cardiogenic edema, the main indicator will be the measurement of wedge pressure. Normal cardiac output, positive wedge pressure results suggest non-cardiogenic edema.

Consequences of pulmonary edema

Sequelae of pulmonary edema
Sequelae of pulmonary edema

When the edema is stopped, it is too early to finish the treatment. After an extremely severe condition of pulmonary edema, serious complications often occur:

  • accession of a secondary infection. The most common is pneumonia. Against the background of reduced immunity, even bronchitis can lead to adverse complications. Pneumonia associated with pulmonary edema is difficult to treat;
  • hypoxia, characteristic of pulmonary edema, affects vital organs. The most serious effects can affect the brain and cardiovascular system - the effects of edema may be irreversible. Violation of cerebral circulation, cardiosclerosis, heart failure without powerful pharmacological support lead to death;
  • ischemic damage to many organs and systems of the body;
  • pneumofibrosis, segmental atelectasis.

Emergency care for pulmonary edema

Required for every patient with signs of pulmonary edema. First Aid Highlights:

  • the patient needs to be given a semi-sitting position;
  • aspiration (removal) of foam from the upper respiratory tract. Aspiration is performed by inhaling oxygen through 33% ethanol;
  • urgent oxygen inhalation (oxygen therapy);
  • elimination of acute pain syndrome with neuroleptics;
  • restoring heart rate;
  • electrolyte balance correction;
  • normalization of acid-base balance;
  • Urgent care
    Urgent care
  • normalization of hydrostatic pressure in the pulmonary circulation. Narcotic analgesics are used. They depress the respiratory center, relieve tachycardia, reduce venous blood flow, lower blood pressure, reduce anxiety and fear of death;
  • vasodilators - lower vascular tone, intrathoracic blood volume. Nitroglycerin preparations facilitate the outflow of blood from the lungs by acting on peripheral vascular resistance;
  • imposition of venous tourniquets on the lower limbs. The procedure is necessary to reduce the CTC - an old effective method;
  • prescribing diuretics to dehydrate the lungs;
  • appointment of cardiac glycosides to increase myocardial contractility;
  • immediate hospitalization.

Major complications after emergency care

Such complications include:

  • development of a lightning-fast form of edema;
  • Intensive production of foam can cause airway obstruction;
  • depression (oppression) of breathing;
  • tachyarrhythmia, asystole;
  • angio pain. Such pain is characterized by an unbearable pain syndrome, the patient may experience a pain shock that worsens the prognosis;
  • impossibility of BP stabilization. Often, pulmonary edema occurs against the background of low and high blood pressure, which can alternate within a large amplitude. The vessels will not be able to withstand such a load for a long time and the patient's condition worsens;
  • increasing pulmonary edema due to high blood pressure.

Pulmonary edema treatment

Treatment of pulmonary edema
Treatment of pulmonary edema

It boils down to one thing - swelling should be removed as soon as possible. Then, after intensive treatment of the pulmonary edema itself, drugs are prescribed to treat the disease that provoked the edema.

The main task is to get the patient to the hospital as soon as possible! Treatment at home is contraindicated!

Algorithm for the treatment of pulmonary edema

The treatment algorithm itself can be divided into 7 stages:

  1. sedative therapy;
  2. defoaming;
  3. vasodilating therapy;
  4. diuretics;
  5. cardiac glycosides for cardiogenic edema and glucocorticoids for non-cardiogenic;
  6. blood exfusion;
  7. after the relief of edema - hospitalization for the treatment of the underlying disease.

For the relief of 80% of cases of pulmonary edema, morphine hydrochloride, furosemide and nitroglycerin are enough.

Then start therapy for the underlying disease:

  • in case of liver cirrhosis, hyperalbuminemia, a course of hepatoprotectors is prescribed;
  • if edema is caused by pancreatic necrosis, drugs are prescribed to depress the pancreas, then stimulate healing of the necrosis, along with powerful enzyme therapy;
  • complex therapy for myocardial infarction;
  • a course of antibiotics is needed for bronchopulmonary diseases;
  • Glucocorticosteroids, mucolytics, expectorants, bronchodilators are prescribed for a severe asthma attack;
  • prescribe antihistamines for toxic shock;

Prognosis after pulmonary edema is rarely favorable. For survival within a year, it is necessary to be under observation. Effective therapy of the underlying disease that caused pulmonary edema significantly improves the patient's quality of life and prognosis.

Therapy of pulmonary edema in the first place comes down to actually removing the edema itself. Therapy in the hospital is aimed at treating the disease that provoked the edema.

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