Pulmonary edema

What is pulmonary edema?

results from excessive movement of fluid from the pulmonary vascular system to the extravascular system air spaces of the lungs.

What kind of pulmonary disorder is pulmonary edema

Restrictive

What is leading cause?

Heart disease

Normal LVEF values

55%-70%

May confirm heart failure

LVEF less than 40%

Life threatening and cardiac arrythmias

LVEF less than 35%

What happens when LEVF is low?

blood pressure inside the pulmonary veins and capillaries increases causing fluid to be pushed through the capillary walls and inside the alveoli in the form of a transudate.

Hydrostatic pressure

10-15

What is the purpose of hydrostatic pressure?

moves fluid out of the pulmonary capillaries into the interstitial space

How is the stability of pressure determined within the pulmonary pressure?

Balance between hydrostatic and oncotic pressures

When does oncotic pressure loses its holding?

when the hydrostatic pressure rises more than 25 to 30

What is the cardiogenic pulmonary edema?

Left ventricle is unable to pump during ventricular contraction.

How can we identify the ability of left ventricular ejaction

echocardiogram that reflects the patients left ventricular systolic cardiac contractility.

Non cardiac pulmonary edema

less common and develops as a result of damage to the lungs

What happens during non-cardiac pulmonary edema?

lungs issues become inflamed and swollen and fluid can readily leak from the pulmonary capillaries into the alveoli

Increased capillary permeability

-Alveolar hypoxia

-Acute respiratory distress syndrome

-Inhalation of toxic agents

-Pulmonary infections

-Therapeutic radiation

-Acute head injury

Clinical manifestations associated with pulmonary edema

-Atelectasis

-Increased alveolar capillary membrane thickness

-Excessive bronchial secretions

Vital signs

-Cheyne-stokes respirations

-Paroxysmal nocturnal dyspnea and orthopnea

-Cyanosis

-Cough & sputum (frothy & pink) in appearance

Chest assessment

-increased tactile & vocal fremitus

-Crackles & Wheezing

Chest radiograph

-bilateral fluffy opacites

-dilated pulmonary arteries

-Left ventricular hypertrophy (cardiomegaly)

-Kerly A & B

-Bat’s wings or butterfly pattern

-Pleural effusion

Non cardiogenic radiograph

-fluffy densities

-infiltrates either unilateral or bilateral

-Pleural effusion

-Cardiac silhouette is not enlarged

Treatments

Cardiogenic: based on the cause, the severity

Non cardiogenic: ensuring adequate ventilation and oxygenation

How big is the heart during pulmonary edema?

Greater than half the diameter