Pulmonary edema complaints. Pulmonary edema: Clinical picture, signs, pathogenesis, diagnosis, causes, treatment

Pulmonary edema is a pathological condition that is caused by the perspiration 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 the walls of the alveoli, as a result of which fluid from the capillaries enters 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, leads 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 into the bloodstream (sepsis), pneumonia (pneumonia), drug overdose (Fentanyl, Apressin), radiation damage to the lungs, drug intake - heroin, cocaine; toxins violate the integrity of the alveolocapillary membrane, as a result, its permeability increases, and the liquid from the capillaries enters the extravascular space;
• heart disease in the stage of decompensation, accompanied by left ventricular failure and blood congestion in the pulmonary circulation (, heart defects);
• pulmonary diseases leading to stagnation in the right circle of blood circulation (bronchial asthma, pulmonary emphysema);
• thromboembolism of the pulmonary artery (in persons predisposed to thrombosis (suffering from hypertension, etc.), a thrombus may form, followed by its detachment from the vascular wall and migration with the bloodstream through the body; reaching the branches of the pulmonary artery, a thrombus can clog its lumen, which will cause an increase in pressure in this vessel and the capillaries branching off from it - hydrostatic pressure increases in them, which leads to pulmonary edema);
• diseases accompanied by a decrease in the protein content in the blood (cirrhosis of the liver, kidney pathology with nephrotic syndrome, etc.); under these conditions, oncotic blood pressure decreases, which can cause pulmonary edema;
• intravenous infusion (infusion) of large volumes of solutions without subsequent forced diuresis leads to an increase in the hydrostatic pressure of the blood 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 alveolar.

According to the rate of progression of symptoms, the following forms of pulmonary edema are distinguished:

• acute (signs of alveolar edema appear 2–4 hours after signs of interstitial edema appear) - occurs with mitral valve defects (more often after psychoemotional stress or excessive physical exertion), myocardial infarction;
• subacute (lasts from 4 to 12 hours) - develops as a result of fluid retention in the body, with acute hepatic or congenital heart defects and major vessels, lesions of the lung parenchyma of a toxic or infectious nature;
• protracted (lasting 24 hours or more) - occurs with 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 with anaphylactic shock, extensive myocardial infarction.

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

The main signs of pulmonary edema are:

• intense dyspnea 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 agonizing suffocation), aggravated by the patient lying on his back; such a patient takes the so-called forced position - orthopnea - sitting with the body tilted forward and support on outstretched arms;
• pressing, constricting chest pain caused by lack of oxygen;
• severe tachycardia (heart palpitations);
• cough with distant wheezing (audible at a distance), pink frothy sputum;
• pallor or blue discoloration (cyanosis) of the skin, profuse sticky sweat - the result of the centralization of blood circulation in order to provide oxygen to vital organs;
• excitement 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, for the doctor, first of all, his complaints and anamnesis data are important - he conducts a detailed questioning of the patient in order to establish the possible cause of pulmonary edema. In the case when the patient is not available to 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 attracted by pallor or cyanosis of the skin, swollen, throbbing veins of the neck (jugular veins) as a result of stagnation of blood in the pulmonary circulation, rapid or shallow breathing of the subject.

Palpation can be noted cold sticky sweat, as well as an increase in the patient's pulse rate and its pathological characteristics - it is weak filling, threadlike.

With percussion (tapping) of the chest, there will be a dullness of the percussion sound over the lung region (confirms that the lung tissue has increased density).

With auscultation (listening to the lungs with a phonendoscope), hard breathing is determined, a mass of wet large-bubble rales, first in the basal, then in all other parts of the lungs.

Blood pressure is often increased.

From laboratory research methods for the diagnosis of pulmonary edema, the following are important:

• a general blood test - will confirm the presence of an infectious process in the body (leukocytosis is characteristic (an increase in the number of leukocytes), with a bacterial infection, an increase in the level of stab neutrophils, or rods, an increase in ESR).
• biochemical blood test - allows you to differentiate "cardiac" causes of pulmonary edema from the causes caused by hypoproteinemia (a decrease in the level of protein in the blood). If myocardial infarction is the cause of the edema, 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 edema is triggered by a disease accompanied by hypoproteinemia. An increase in urea and creatinine levels indicates a renal nature of pulmonary edema.
• coagulogram (the ability of blood to clot) - will confirm pulmonary edema resulting from pulmonary embolism; the diagnostic criterion is an increase in the level of fibrinogen and prothrombin in the blood.
• determination of blood gas composition.

The patient can be assigned the following instrumental examination methods:

• pulse oximetry (determines the degree of blood oxygen saturation) - with pulmonary edema, its percentage will be reduced to 90% or less;
• determination of the values \u200b\u200bof the central venous pressure (CVP) - carried out using a special device - a Waldmann 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 identified on the ECG or auscultatory; thickening of the walls of the heart chambers, a decrease in the ejection fraction, valve pathology, etc. can be determined;
• chest x-ray - confirms or refutes the presence of fluid in the lungs (darkening of the pulmonary fields on one or both sides), with cardiac pathology - an increase in the size of the shadow of the heart.

Pulmonary edema treatment

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

In the process of transportation to the hospital, the ambulance team takes the following treatment measures:

• the patient is given a semi-sitting position;
• oxygen therapy with an oxygen mask or, if necessary, tracheal intubation and mechanical ventilation;
• sublingual nitroglycerin tablet (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 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 pulse from disappearing) for up to 20 minutes; remove the tourniquets, gradually weakening them.

Further treatment measures are carried out by specialists of the intensive care unit, where the strictest continuous control over hemodynamic parameters (pulse and pressure) and respiration is carried out. Medicines are usually given through the subclavian vein where the catheter is inserted.

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

• to extinguish the foam formed in the lungs - the so-called defoamers (inhalation of oxygen + ethyl alcohol);
• with increased pressure and signs of myocardial ischemia - nitrates, in particular nitroglycerin;
• to remove excess fluid from the body - diuretics, or diuretics (Lasix);
• with low blood pressure - drugs that enhance heart contractions (Dopamine or Dobutamine);
• for pain - narcotic analgesics (morphine);
• if there are signs of PE - drugs that prevent excessive blood clotting, or anticoagulants (Heparin, Fraxiparin);
• with slow heartbeats - Atropine;
• with signs of bronchospasm - steroid hormones (Prednisolone);
• for infections - broad-spectrum antibacterial drugs (carbopenems, fluoroquinolones);
• with 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 not a separate disease, but rather a complication of a number of pathologies. Its essence lies in the excessive accumulation of fluid in the tissues of the lung, its sweating into the lumen of the alveoli, which leads to a deterioration in respiratory functions and the death of the patient.

Anatomy and physiology of the pulmonary gas exchange system

The lungs are a complex of small-diameter hollow tubes, at the end of each of which there are alveoli - saccular thin-walled formations filled with air. All of these structures are enveloped in threads of connective tissue. These threads form a kind of framework that forms the lung itself and is called the interstitium. Part of the interstitium are interalveolar septa, penetrated by capillaries.
The wall of the alveoli and capillary together with the interstitial tissue form an alveolar-capillary membrane (ACM) 0.2-2 microns thick, through which oxygen and carbon dioxide diffuse into / from the blood.

The mechanism and causes of the development of pulmonary edema

Many reasons can lead to the appearance of pulmonary edema (OB), however, regardless of the factor that caused the complication, the mechanism of its development is the same - the accumulation of excess fluid in the interstitial tissues, the thickening of the alveolar-capillary membrane as a result, and a decrease in gas diffusion (primarily oxygen). As a result, tissue hypoxia occurs (oxygen starvation of all tissues) and acidosis - a shift in acid-base balance, leading to the inevitable death of the patient, if he does not receive emergency assistance.
There is no single classification of pulmonary edema, however, according to the pathogenetic mechanism, it can be divided into:

1. OB due to increased capillary pressure as a result of:
   • spicy;
   • heart;
   • cardiomyopathies;
   • myocarditis;
   • exudative pericarditis;
   • pulmonary artery stenosis;
   • massive infusion of blood substitution solutions;
   • renal failure in the anuria phase.
2. OB due to increased permeability of the capillary wall at:
   • acute respiratory distress syndrome;
   • intoxications (for example, drugs);
   • anti-cancer chemotherapy;
   • the use of X-ray contrast agents;
   • inhalation of toxic substances;
   • allergies.
3. OB due to impaired lymph outflow in cancer of the lymphatic vessels.
4. OB due to changes in intrathoracic interstitial pressure during decompression sickness and evacuation (removal) of fluid from the pleural cavity.
5. OB due to a decrease in the protein content in the blood plasma.
6. Mixed OL:
   • neurogenic;
   • postoperative;
   • with eclampsia;
   • with ovarian hyperstimulation syndrome;
   • with altitude sickness.

Previously, a classification was used that includes such types of pulmonary edema as interstitial and alveolar. Currently, it has been abandoned, since these two types of OB are actually only stages of the development of the syndrome. Moreover, in terms of diagnosis and treatment, such a separation has no useful function.
Normally, an extremely small amount of fluid from the interstitium penetrates into the alveoli. Almost all of it is absorbed into the blood and lymphatic capillaries and removed from the alveolar-capillary membrane. However, if the AKM permeability is disturbed, the liquid becomes too much and it does not have time to move all of it into the vessels. In this case, it permeates the interstitium, increasing its thickness, and in the most advanced situation it begins to enter the lumen of the alveoli, further impairing gas exchange.

The symptomatology of pulmonary edema depends little on the factors that led to its development. The difference between OB, caused by disorders in the cardiovascular system, and edema, not associated with cardiac causes, lies only in the speed of development of the pathology.

OB associated with disorders in the circulatory system

With cardiogenic pulmonary edema (caused by circulatory disorders), the first symptom is cardiac asthma, manifested by shortness of breath at rest, increased respiratory movements, a feeling of a sharp lack of air, suffocation. Most often, the attack begins at night, the patient immediately wakes up and takes a sitting position in which it is easier for him to breathe. At the same time, he lowers his legs from the bed, rests his hands on its edge. This is the orthopnea position that almost every patient takes.
For the onset of pulmonary edema, the desire is characteristic to go to the window, to breathe fresh air. In this state, the patient practically does not speak, however, emotional stress is clearly visible on his face. According to the doctors' words, “the patient completely surrenders to the struggle for air.” The skin becomes pale, the nasolabial triangle becomes cyanotic (acrocyanosis). This indicates an increase in hypoxia. The appearance of cold sticky sweat is possible - a sign of impending cardiogenic shock, which is an extremely serious complication of any cardiac pathology. With further development, the patient's breathing becomes noisy, even at a distance, a bubbling is heard in his chest, it is possible to release pink foamy sputum in large volumes. At this stage, the amount of fluid already far exceeds the capillaries' ability to remove it, and the liquid part of the blood begins to penetrate into the alveoli.

Noncardiogenic edema lungs

In this case, the phenomena of pulmonary edema arise due to damage to the alveolar-capillary membrane by various factors (microbial toxins, chemicals, allergy mediators, etc.). Unlike cardiogenic, this type of OB appears only after a relatively long time after exposure to a damaging agent (up to 48 hours). The symptomatology of noncardiogenic pulmonary edema is exactly the same as that of its cardiac form. The only difference is that in cardiogenic OB it is much easier to treat and resolves faster, completely disappearing after 2-4 days. Non-cardiogenic edema has to be treated for 1-3 weeks, very often (up to 80% of cases) it ends in death. But even in the case of successful treatment, this form of OB is accompanied by persistent residual effects.

Diagnosis of pulmonary edema

For the diagnosis of pulmonary edema, anamnesis is very important. And although sometimes they cannot be obtained, however, it is information about already existing diseases that can lead a doctor to think about the causes of complications. After clarifying the anamnesis, the patient is examined and auscultated. At this moment, changes in the color of the skin and mucous membranes, profuse sweat are revealed, attention is drawn to the patient's posture when breathing, his behavior. When listening to the lungs, wheezing, hard breathing are noted, when listening to the heart - muffling of its tones, the "gallop" rhythm, noises. The main indicator of pulmonary edema is a decrease in blood oxygen saturation. To detect it, pulse oximetry is used - a method available to any ambulance brigade.
Hemodynamic disturbances are detected by measuring blood pressure and counting heart rate. It is imperative to conduct emergency electrocardiography, taking into account the patient's condition - this method allows you to identify the causes of the cardiogenic form of edema and develop the optimal treatment tactics. In a hospital, an additional chest X-ray is performed, which reveals signs of pulmonary edema and some pathologies that led to it. With the help of this study, you can relatively accurately differentiate the causes of the disease. Other methods of diagnosing pathology are also used:

• echocardiography, which allows to identify abnormalities or pathology of the heart valves, leading to hemodynamic disturbances;
• pulmonary artery catheterization to detect changes in pressure indicators in this vessel;
• transpulmonary thermodilution to determine the degree of edema;
• biochemical blood test, with the help of which some pathological conditions that can lead to OL are revealed;
• the gas composition of blood is the most important analysis that provides information on the saturation of blood with oxygen and carbon dioxide.

Treatment and emergency care for pulmonary edema

The first thing with which the treatment of OL begins is oxygen therapy. Inhalation of pure oxygen to patients can reduce the degree of hypoxia, straighten the alveoli and improve the transport of gases into the blood. This gives doctors the necessary time to administer medications that can eliminate the pathology. In the presence of hemorrhagic foam, oxygen is passed through a water-alcohol solution, since ethanol is capable of breaking bubbles. In the absence of effect from standard oxygen therapy, they switch to inhalation of oxygen through a breathing mask under pressure. In severe cases, tracheal intubation and mechanical ventilation may be required. Drug therapy depends on the pathology that led to the development of pulmonary edema:

Decrease in systolic blood pressure below 90 mm Hg. Art. is an unfavorable sign. In this case, nitrates are contraindicated even in the presence of a heart attack; dopamine preparations are prescribed instead. A frequent "companion" of cardiogenic pulmonary edema is bronchospasm. When this syndrome is detected, bronchodilators are prescribed.

Prevention of pulmonary edema

Since this syndrome most often occurs in people with chronic diseases, their timely treatment can reduce the likelihood of pulmonary edema. It is impossible to completely exclude its appearance, especially with long-term arrhythmias, coronary heart disease, heart defects and heart failure. However, careful monitoring of the condition by the doctor and the strict implementation of all medical recommendations helps to avoid decompensation of these diseases, and hence the development of their complications, including pulmonary edema. Bozbey Gennady, medical commentator, emergency doctor

Pulmonary edema is a pathology in which intercellular fluid from blood vessels is exudated into the lung tissue and alveoli. In this case, gas exchange is disrupted in the body. Changes occur in the composition of the blood: the level of carbon dioxide rises. A person begins to experience oxygen starvation, the functions of the nervous system are suppressed. If medical assistance is not provided in time for pulmonary edema, death occurs.

This condition is divided into two types:

• membranogenic, that is, with a sharp increase in the level of blood vessel permeability;
• hydrostatic, that is, associated with diseases that increase the pressure in the capillaries.

The reasons for the development of edema

Edema, sometimes referred to as cardiac asthma, can be associated with the following:

• diseases of the circulatory system, in which blood stagnates in the pulmonary circulation (any diseases in the stage of decompensation);
• overdose of drugs or narcotic substances;
• formation of a blood clot in the pulmonary artery;
• poisoning with poisonous substances or toxic gases;
• kidney pathology, in which the level of protein in the blood decreases;
• blood poisoning;
• pneumonia;
• hypertensive crisis;
• stagnation of blood in the right circle of blood circulation is usually associated with bronchial asthma, emphysema and other respiratory diseases;
• shock caused by trauma;
• radiation sickness.

Symptoms of edema

Excessive exercise, a sudden change in body position, or severe stress can provoke pulmonary edema. When the pathology is just incipient, a person feels shortness of breath and wheezing in the chest, breathing becomes more frequent.

Initially, fluid collects in the interstitium of the lungs. This condition is accompanied by the following symptoms:

• a tight feeling in the chest;
• frequent unproductive cough;
• sharp blanching of the skin;
• labored breathing;
• tachypnea;
• a feeling of anxiety and panic, confusion is possible;
• hypertension;
• heart palpitations;
• increased sweating;
• bronchospastic syndrome.

When fluid enters the alveoli, the second stage begins - alveolar pulmonary edema. The patient becomes sharply worse. To relieve pain, the patient assumes a sitting position, leaning on outstretched arms. This stage of edema is accompanied by the following symptoms:

• wet and dry wheezing;
• increased shortness of breath;
• bubbling breath;
• suffocation increases;
• cyanosis of the skin;
• swelling of the neck veins;
• heart rate increases up to 160 beats per minute;
• confused consciousness;
• blood pressure drops;
• the patient feels fear of death;
• threadlike and poorly palpable pulse;
• foamy pink sputum is released;
• in the absence of timely medical care, a coma.

An attack can compromise the integrity of the airways and lead to death of the victim.

A person with pulmonary edema needs emergency care. It is necessary to perform the following actions:

• at the first symptoms of cardiac asthma, call an ambulance;
• help the patient to take a half-sitting or sitting position, while his legs should be lowered;
• put the patient's feet in a basin of hot water;
• open windows, giving the victim access to fresh air, remove or unfasten tight clothing that interferes with breathing;
• control breathing and pulse;
• if you have a tonometer, measure your blood pressure;
• if the heart pressure is above 90, give the person one nitroglycerin tablet sublingually;
• put venous tourniquets on the legs in order to retain venous blood in them and reduce the load on the heart;
• tourniquets are applied to the lower limbs in turn and can be on them for no more than 20 minutes;
• after normalization of pressure, intravenously inject the victim (for example, lasix) to reduce the amount of fluid in the lungs;
• carry out inhalations with 96% (for children 30%) with an aqueous solution of alcohol, which has an anti-foaming effect.

After the above manipulations, it is required to wait for an ambulance, which stops pulmonary edema and takes the patient to intensive care. There, doctors determine what caused the pathology, and the doctor of the corresponding specialty is engaged in further treatment.

Urgent care for edema

Immediately after arrival, ambulance doctors should inject a patient with pulmonary edema into a vein with a narcotic anesthetic (Morphine, Promedol) to normalize the hydrostatic pressure in the pulmonary circulation, a diuretic and nitroglycerin. During transportation to the hospital, the following steps are taken:

• the patient is placed so that the upper half of the body is raised;
• in the absence of diuretics, turnstiles are applied to the lower limbs, the pulse on the arteries should be preserved;
• oxygen therapy is performed (if required, a tube is inserted into the trachea and artificial ventilation of the lungs is performed);
• the composition of the solution for inhalation should include a defoamer (70–96% aqueous solution of ethyl alcohol), which reduces the tension of the exudate;
• every 30–40 minutes of inhalation, the patient must breathe pure oxygen for 10 minutes;
• an electric suction is used to remove foam from the upper respiratory tract;
• if a blood clot forms in the pulmonary artery, blood thinning anticoagulants are used;
• if the patient has atrial fibrillation, he is injected with a drug from the group of cardiac glycosides;
• with nausea, vomiting or tachycardia of the ventricles, glycosides cannot be used;
• if the pulmonary edema is caused by a drug overdose, drugs are used to reduce muscle tone;
• with a diastolic pressure of more than 100, 50 μg of nitroglycerin is required intravenously;
• with bronchospastic syndrome, the patient is given Methylprednisolone or;
• if the heart rate is less than 50 beats per minute, use Euphyllin in combination with Atropine;
• if the victim has bronchial asthma, a standard dose of pentamine or sodium nitroprusside is administered.

Therapy for pulmonary edema

Further care for pulmonary edema should be provided by resuscitation or intensive care physicians. Pulse, pressure, and respiration should be monitored continuously. All medications are given through a catheter inserted into the subclavian vein.

After the edema is arrested, treatment of the pathology that caused it begins. Antibiotics and antiviral therapy are needed to treat edema of any origin.

Diseases of the respiratory system are treated with antibiotics from the group of macrolides and fluoroquinolones, which have an expectorant and anti-inflammatory effect. Penicillin is rarely used due to its low effectiveness. Together with antibiotics, immunomodulators are prescribed that affect the immune system and prevent the recurrence of infection.

If the swelling is caused by intoxication, medications are prescribed to relieve symptoms and, if necessary, an antiemetic. After diuretics, it is also necessary to restore the body's water-salt balance.

From the severe form of acute pancreatitis, they get rid of medicines that inhibit the work of the pancreas. In addition to them, enzyme preparations and agents are prescribed that accelerate the healing of necrosis foci.

Asthma attacks are removed with glucocorticosteroids, bronchodilators, and phlegm thinners.

With cirrhosis of the liver, drugs are prescribed to protect it and thioctic acid.

If the cause of the pathology is myocardial infarction, beta-blockers, drugs that prevent the formation of blood clots, and angiotensin-converting enzyme inhibitors are required.

The prognosis after cardiac asthma is usually good, but the patient must be examined by a doctor within a year.

Possible complications after pulmonary edema

With illiterate first aid for pulmonary edema, a person's condition can worsen and lead to complications:

• pathology can turn into a lightning-fast form, and doctors will not have time to provide assistance in time;
• if too much foam is produced, it blocks the airways;
• with edema, breathing is inhibited;
• pressing or squeezing pain behind the sternum can cause painful shock;
• blood pressure drops with a significant amplitude, subjecting the blood vessels to an enormous load;
• significant increase in heart rate, circulatory arrest.

Acute pulmonary edema is a violation of the circulation of blood and lymph, which causes the active release of fluid from the capillaries into the tissue of the named organ, which ultimately provokes a violation of gas exchange and leads to hypoxia. Acute edema grows rapidly (the duration of an attack is from half an hour to three hours), which is why even with timely resuscitation actions it is not always possible to avoid a lethal outcome.

How does acute pulmonary edema develop?

Acute pulmonary edema, the cause of death in many patients, develops as a result of infiltration into the lung tissue, where it collects in such quantities that the ability to pass air is greatly reduced.

Initially, the named edema has the same character as the edema of other organs. But the structures that surround the capillaries are very thin, which is why the fluid immediately begins to enter the alveolar cavity. By the way, it also appears in the pleural cavities, albeit to a much lesser extent.

Diseases that can cause acute pulmonary edema

Acute pulmonary edema is the cause of death in the course of many diseases, although in some cases it can still be stopped with medication.

Diseases that can provoke pulmonary edema include pathologies of the cardiovascular system, including lesions of the heart muscle in hypertension, congenital malformations and congestion in the systemic circulation.

No less frequent causes of pulmonary edema are severe cranial trauma of various etiologies, as well as meningitis, encephalitis and various brain tumors.

It is natural to assume the cause of pulmonary edema is in diseases or lesions such as pneumonia, inhalation of toxic substances, chest trauma, allergic reactions.

Surgical pathologies, poisoning, and burns can also lead to the described edema.

Types of pulmonary edema

Patients most often have two main, radically different types of pulmonary edema:

• cardiogenic (cardiac pulmonary edema), caused by blood congestion in the lungs;
• noncardiogenic, caused by increased permeability, acute damage to the named organ or acute respiratory distress syndrome;
• the toxic edema of the noncardiogenic type is considered separately.

However, despite the fact that the causes of their occurrence are different, these edema can be very difficult to differentiate due to similar clinical manifestations of an attack.

Pulmonary edema: symptoms

Emergency care provided on time for pulmonary edema still gives the patient a chance to survive. For this, it is important to know all the symptoms of this pathology. They manifest themselves quite clearly and are easily diagnosed.

• At the beginning of the development of an attack, the patient often coughs, his hoarseness increases, and his face, nail plates and mucous membranes become cyanotic.
• The suffocation increases, accompanied by a feeling of tightness in the chest and pressing pain. For relief, the patient is forced to sit down and sometimes bend forward.
• The main signs of pulmonary edema appear very quickly: rapid breathing, which becomes hoarse and bubbling, weakness and dizziness appear. Veins in the neck area swell.
• Coughing up pink, frothy sputum. And if the condition worsens, it can also stand out from the nose. The patient is frightened and may be confused. The limbs, and then the whole body, become wet with cold, clammy sweat.
• The pulse quickens up to 200 beats per minute.

Features of toxic pulmonary edema

A slightly different picture is presented by toxic pulmonary edema. It is caused by poisoning with barbiturates, alcohol, as well as the penetration of poisons, heavy metals or nitric oxides into the body. Burns of lung tissue, uremia, diabetic, can also provoke the described syndrome. Therefore, any severe asthma that occurs in these situations should lead to suspicion of pulmonary edema. Diagnosis in these cases must be thorough and competent.

Toxic edema often occurs without characteristic symptoms. For example, with uremia, very scarce external signs in the form of chest pain, dry cough, and tachycardia do not correspond to the picture seen on X-ray examination. The same situation is typical for toxic pneumonia, and in the case of metal carbonite poisoning. And poisoning with nitrogen oxides can be accompanied by all the signs of edema described above.

First non-drug treatment for pulmonary edema

If the patient has symptoms accompanying pulmonary edema, emergency care should be provided even before being admitted to the intensive care unit. The necessary measures are carried out by an ambulance team on the way to the hospital.

Medication for pulmonary edema

The variety of manifestations accompanying an attack has led to the fact that many drugs are used in medicine that can relieve acute pulmonary edema. In this case, the cause of death may lie not only in the pathological condition itself, but also in the incorrectly selected treatment.

One of the drugs used to relieve edema is morphine. It is especially useful if the attack was caused by hypertension, mitral stenosis, or uremia. Morphine reduces shortness of breath by oppressing the respiratory center, relieves stress and anxiety in patients. But at the same time it is able to increase intracranial pressure, which is why its use in patients with cerebrovascular accidents should be very careful.

To reduce the hydrostatic intravascular pressure in pulmonary edema, drugs "Lasix" or "Furosemide" are used intravenously. And to improve pulmonary blood flow, heparin therapy is used. Heparin is administered as a bolus (jet) at a dose of up to 10,000 IU intravenously.

Cardiogenic edema, in addition, requires the use of cardiac glycosides ("Nitroglycerin"), and non-cardiogenic - glucocorticoids.

Severe pains are relieved with Fentanyl and Droperidol preparations. If it is possible to stop the attack, therapy of the underlying disease begins.

Pulmonary edema: consequences

Even if relief of pulmonary edema is successful, treatment does not end there. After such an extremely difficult condition for the whole organism, patients often develop serious complications, most often in the form of pneumonia, which in this case is very difficult to treat.

Oxygen starvation affects almost all organs of the victim. The most serious consequences of this can be disorders of cerebral circulation, heart failure, cardiosclerosis and ischemic organ damage. These conditions are not complete without constant and enhanced drug support, they, despite the arrested acute pulmonary edema, are the cause of death of a large number of patients.

Pulmonary edema is a pathological condition that occurs suddenly and is accompanied by the sweating of fluid from the capillaries into the interstitial tissue of the lungs and alveoli. This pathology leads to disruption of gas exchange and oxygen starvation of tissues and organs. It is manifested by severe suffocation, cough (at first dry, and then with copious amounts of pink foamy sputum), shortness of breath and cyanosis of the skin. Failure to provide emergency care can be fatal.

Pulmonary edema can debut with shortness of breath and chest pain.

Pulmonary edema can be triggered by physical exertion, the transition of the body from vertical to horizontal position, or psycho-emotional arousal. In some cases, it can begin with precursors: increased breathing, increasing shortness of breath, and coughing with moist wheezing.

According to the rate of development, pulmonary edema can be:

• acute: develops within 2-3 hours;
• lightning-fast: the death of the patient is caused by suffocation within a few minutes;
• protracted: develops over several hours or days.

At the beginning of an attack in a patient, fluid accumulates in the interstitial tissue of the lungs: interstitial pulmonary edema. This condition is accompanied by the following symptoms:

• pain or feeling of pressure in your chest;
• increased breathing;
• frequent coughing without sputum;
• possible bronchospasm;
• increasing with difficulty breathing in and out;
• feeling short of breath;
• tachycardia;
• increased blood pressure;
• cold clammy sweat;
• sharp pallor;
• growing weakness;
• increased sweating;
• anxiety.

The patient seeks to take a forced position: he sits on the bed, legs dangling, and rests on outstretched arms. With the transition of fluid to the alveoli and the beginning of alveolar pulmonary edema, the patient's condition deteriorates significantly:

• shortness of breath increases, breathing becomes bubbling;
• suffocation increases;
• the skin becomes bluish-gray;
• the cough gets worse;
• frothy pink sputum appears;
• veins in the neck are swollen;
• grows (up to 140-160 beats per minute);
• the pulse becomes weak and threadlike;
• a decrease in blood pressure is possible;
• the patient is afraid of death;
• confusion appears;
• in the absence of adequate assistance, the patient may fall into a coma.

During an attack, a violation of the integrity of the airways and death can occur.

After stopping an attack of pulmonary edema, the patient may develop severe complications:

• pneumonia and bronchitis (due to the addition of a secondary infection);
• disorders of cerebral circulation;
• segmental atelectasis;
• pneumofibrosis;
• ischemic lesions of organs and systems.

First aid emergency aid

1. At the first signs of pulmonary edema, the patient or his environment should call an ambulance.
2. Give the patient a half-sitting or sitting position with the legs down.
3. Provide an adequate supply of fresh air, open windows and vents, remove clothing that restricts breathing from the patient.
4. Constantly monitor breathing and pulse.
5. Measure (if possible) blood pressure.
6. Lower the patient's legs into hot water.
7. Apply a tourniquet to the thigh for 30-50 minutes, then apply it to the other thigh.
8. Inhalation of alcohol vapors (for adults 96%, for children 30%).
9. At a pressure of at least 90 mm. rt. Art. give the patient a nitroglycerin tablet under the tongue.
10. Give the patient a Furosemide (Lasix) tablet.

Emergency medical care

After the arrival of the ambulance team, the patient is injected intravenously with a narcotic analgesic (Morphine, Promedol), Lasix and Nitroglycerin. During transportation to the hospital, the following activities are performed:

Emergency care and treatment in a hospital setting

Treatment of pulmonary edema in the emergency department is carried out under constant monitoring of blood pressure, pulse and respiratory rate. Most drugs are administered through a subclavian vein catheter. The treatment regimen is determined for each patient individually, depending on the causes of pulmonary edema.

The complex of treatment may include such drugs and activities:

During the treatment of pulmonary edema, the patient should adhere to a diet that restricts table salt, liquids and fats, completely exclude respiratory and physical exertion. After the course of treatment of the underlying disease, the patient must be under the outpatient supervision of a doctor.