Pulmonary edema: Signs and Treatment Guidelines

Pulmonary edema is the accumulation of excessive fluid in the alveolar walls and alveolar spaces of the lungs. It is an acute medical emergency that occurs due to an increase in pulmonary capillary venous pressure leading to an accumulation of fluid in the alveoli usually due to acute left ventricular failure.

Edema is excessive fluid accumulation in the interstitial spaces, beneath the skin or within the body cavities.

There exist different types of edema such as peripheral edema, cerebral edema, pulmonary edema, macular edema, and lymphedema.

Causes of pulmonary edema

All the factors which contribute to increased pressure on the left side and pooling of blood on the left side of the heart can cause cardiogenic pulmonary edema.

The result of all these conditions will be increased pressure on the left side of the heart: increased pulmonary venous pressure--> increased capillary pressure in lungs--> pulmonary edema.

Coronary artery disease with left ventricular failure (myocardial infarction)

Congestive heart failure

Cardiomyopathy

Valvular heart diseases on the left side of the heart (stenosis and regurgitation)

Cardiac arrhythmias

Signs and symptoms

The patient will present with

Breathlessness,
Sweating,
Cyanosis,
Frothy blood-tinged sputum,
Respiratory distress,
Rhonchi and crepitations on auscultation.
Elevated jugular venous pressure.

Diagnostic Investigations

Chest x-ray reveals loss of distinct vascular margins, Kerley B lines and diffuse haziness of lung fields.

Management of pulmonary edema

Management must be immediate:

ABC protocol must be assessed very fast in these patients

The patient should be positioned in a propped up position in bed.

Obtain an intravenous line.

Give 100% oxygen at a rate of 3.5–5 Liters per minute.

Ventilatory support may also be required.

Start intravenous frusemide 40 milligrams initially and a repeat with a higher dose every 20–30 minutes up to 200mg maximum total dose.

If the patient is not already on digoxin, you may need to digitalize except where the edema resulted due to myocardial infarction, heart failure, and, acute myocardial infarction.

Treatment of the underlying cause is key.

Non Invasive Management

Non-Invasive Management can be achieved by

pre-Load Reduction using; Nitroglycerin, Sodium nitroprusside, Isosorbide dinitrate, Loop diuretics, Morphine, and nesiritide require extreme care, BIPAP.

After-Load Reduction using ACE inhibitors or angiotensin receptor-neprilysin inhibitor: captopril, enalapril, lisinopril, perindopril, Angiotensin receptor blockers, Sodium nitroprusside