Acute Pulmonary Edema

DEFINITION

Abnormal accumulation of fluid in the

extravascular spaces and tissues of the lung.
 ETIOLOGI

Cardiogenic pulmonary edema (also

termed hydrostatic or hemodynamic edema)
Noncardiogenic pulmonary edema (also
known as increased-permeability pulmonary
edema, acute lung injury, or acute
respiratory distress syndrome)
Difficult to distinguish because of their
similar clinical manifestations
 Cardiogenic Pulmonary
Edema -- Causes:
Left ventricular failure
Volume overload
Mechanical obstruction of left outflow tract e.g.
Mitral stenosis
Aortic valvular diseases & also in congestive
failure and hypertension
AMI
cardiomiopathy
Causes of Non-cardiac Pul.
Edema
Toxins: eg. Smoke, ozone, phosgene, chlorine, Nitrogen
dioxide, cadmium
Trauma and burns
Aspiration of gastric contents
Acute radiation Pneumonitis
D.I.C.
Near drowning
Emboli
Multiple transfusion
Drug related: Thiazides, salicylates, interleukin-2,
colchicine, chlordiazepoxide
 PATHOPHYSIOLOGY

Microvascular Fluid Exchange in the Lung

Fluid and solutes that are filtered from the

circulation into the alveolar interstitial space
Do not enter the alveoli because the alveolar
epithelium is composed of very tight junctions
It moves proximally into the peribronchovascular
space
The lymphatics remove most of this filtered fluid
from the interstitium and return it to the systemic
circulation
 PATHOPHYSIOLOGY

Microvascular Fluid Exchange in the Lung

Increased hydrostatic pressure in the

pulmonary capillaries
elevated pulmonary venous pressure
increased left ventricular end-diastolic pressure
and left atrial pressure
As left atrial pressure rises further (>25 mm
Hg)
edema fluid breaks through the lung epithelium
flooding the alveoli with protein-poor fluid
 PATHOPHYSIOLOGY

Microvascular Fluid Exchange in the Lung

Noncardiogenic pulmonary edema

increase in the vascular permeability of the lung
resulting in an increased flux of fluid and
protein into the lung interstitium and air spaces
 History

Interstitial edema causes dyspnea and

tachypnea
Alveolar flooding leads to arterial
hypoxemia
Cough and expectoration of frothy edema
fluid
 History

Cardiogenic pulmonary edema

ischemia with or without myocardial infarction
exacerbation of chronic systolic or diastolic heart failure,
and dysfunction of the mitral or aortic valve
paroxysmal nocturnal dyspnea or orthopnea
Noncardiogenic pulmonary edema
pneumonia
sepsis
aspiration of gastric contents
major trauma associated with the administration of
multiple blood-product transfusions
 Physical Examination

Cardiogenic pulmonary edema

auscultation of an S3 gallop
a murmur consistent with valvular stenosis or
regurgitation
elevated neck veins, an enlarged and tender liver, and
peripheral edema
cool extremities
Noncardiogenic pulmonary edema
abdominal, pelvic, and rectal examinations are
important
warm extremities
 Clinical Manifestations

Dyspnea
Sudden
Orthopnea
Cyanotic (central)
air hunger
Tachypnea
Cough
Copious sputum
Frothy Pink Frothy Sputum
Blood tinged
 Clinical Manifestations

Pulse
Tachycardia
Bounding
Breath Sound
Crackles
Fine course
Engorged neck & hand
veins
 Clinical Manifestations

Diaphoretic
Clammy
Anxiety
Confusion
Stupor
 Investigation

X-ray
Pulse oximetry
i
Electrocardiography
Pulmonary-Artery
Catheterization
Echocardiography
 Laboratory Testing

Elevated troponin levels

Measurement of electrolytes, the serum
osmolarity, and a toxicology screen
ABGs
PaO2 i, hypoxia, metabolic acidosis

Serum amylase and lipase

 Treatment

Goal:
Remove fluid
h oxygenation
O2
Mask
Non-rebreather
CPAP
Mech. Vent
PEEP
 Treatment
Diuretics
Lasix
Digitalis / Digoxin lanoxin
Bronchodilators
Aminophylline
Morphine
i peripheral resistance
i pressure in pulmonary
capillaries
i anxiety
 Summary

Acute Pulmonary Edema is life-

threatening
Progressive assessment, Treatment &
nursing management can improve outcome
& survive of Acute Pulmonary Edema
patients
Thanks You