ACUTE PULMONARY
OEDEMA
Master Achese Reginald
OUTLINE
• Introduction
• Epidemiology
• Pathophysiology
• Types
• Clinical features
• Investigation
• Treatment
• Complications
• Prognosis
• References
INTRODUCTION
• Acute pulmonary oedema is a medical emergency that results
accumulation of fluid in the lungs caused by an extravasation of fluid
from the pulmonary vasculature into the interstitium and alveoli of
the lungs.
• Acute pulmonary oedema is characterized by dyspnea and hypoxia
leading to impairment in gas exchange and lung compliance
EPIDEMIOLOGY
• It occurs in about 1-2% of the general population
• Males between the ages of 40-75years are more common than
females
• After the age of 75years, males and females are affected equally
• The incidence of pulmonary oedema increases with age and may
affect about 10% of the population over the age of 75years
• Hospital mortality rate ranges from 4-10%
• Hospital readmission ranges from 15%(1month) to 45-50%(6months)
• 1 in 3 patients die in one year
PATHOPHYSIOLOGY
• Acute pulmonary oedema can be caused by some pathophysiological
mechanism which includes;
A. Imbalance in starling forces
• Increased pulmonary capillary pressure
• Decreased plasma oncotic pressure
• Increased negative interstitial pressure
B. Damage to the alveoli capillary barrier
C. Lymphatic obstruction
D. Idiopathic mechanism
TYPES
• There are two major types of pulmonary oedema
A. Cardiogenic/hydrostatic pulmonary oedema: This occurs as a result
of a heart disease and the commonest cause is left sided heart
failure
B. Non cardiogenic pulmonary oedema: this occurs as a result of a
damage in the pulmonary capillaries or alveoli. There is usually
minimal elevation of pulmonary capillary pressure. The oedema
may be caused by altered alveolar capillary membrane
permeability. The mechanism of non cardiogenic pulmonary
oedema is unknown in some conditions like narcotic overdose, high
altitude or neurogenic pulmonary oedema
CLINICAL FEATURES
• SYMPTOMS
• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Cough(pink or whitish sputum)
• SYMPTOMS SUGGESTIVE OF UNDERLYING CAUSE
• Pneumonia; fever, chest pain, fast breathing
• Aspiration; difficulty in breathing, cough, choking
CLINICAL FEATURES
• SIGNS
• SPO2<90%
• Pallor
• Fever
• Hypoxia
• Tachycardia
• Tachypnea
• Raised JVP
• Bilateral crackles
• Peripheral oedema
INVESTIGATION
• The diagnosis of pulmonary oedema is mainly made with a
A. chest Xray
• Peribronchial thickening
• Prominent vascular markings
• Kerley B sign
• Patchy alveoli filling, typically in a perihilar distribution and diffuse
alveolar infiltrate
• cardiomegaly
B. chest CT scan
C. ECHO
D. ECG
E. Liver function test
F. Kidney function test
G. E/U/Cr
H. Troponin
I. BNP
J. Arterial blood gases
TREATMENT
GOALS OF MANAGEMENT
• Improve oxygenation
• Maintain adequate blood pressure
• Reduce excess cellular fluid
• Treating the underlying cause
TREATMENT
It is a medical emergency
• Admit
• Resuscitation
• Decrease preload using glyceryl trinitrate
• If there are signs of CCf give frusemide
• If patient does not respond and there is still hypoxia, shortness of
breath and they are distressed give CPAP
• Identify and treat the cause once patient is stable
COMPLICATIONS
• Respiratory failure
• Pleural effusion
• Sepsis
• Electrolyte derangement
• Cardiogenic shock
PROGNOSIS
• The prognosis is dependent on the underlying cause and immediate
treatment
• There is high mortality rate associated with acute pulmonary oedema
occurring due to sepsis but the mortality rate is low when acute
pulmonary oedema occurs due to trauma, aspiration
• Mortality increase with increasing age and organ failure
CONCLUSION
• In conclusion, acute pulmonary oedema is a medical emergency that
may occur from cardiogenic or non cardiogenic causes therefore
prompt management has to be done to reduce mortality rate
REFERENCES
• Davidson
• Oxford handbook of medicine
• Medscape
• Osmosis
THANK YOU
