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Key Features

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  • Dyspnea and oxygen requirement

  • Evidence of pulmonary edema on chest imaging

  • Defined as excessive accumulation of extravascular fluid in the lung

  • There are two basic types

    • Increased pressure (cardiogenic or hydrostatic); usually due to excessive increases in pulmonary venous pressure, in the setting of heart failure

    • Increased permeability (noncardiogenic or primary); occurs when airway occlusion (or its sudden relief) causes a sudden drop in airway pressure, which leads to increased venous return and decreased left heart blood flow

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Clinical Findings

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  • Cyanosis

  • Tachypnea

  • Tachycardia

  • Respiratory distress

  • Rales, diminished breath sounds, and (in young infants) expiratory wheezing

  • More severe disease is characterized by

    • Progressive respiratory distress with marked retractions

    • Dyspnea

    • Severe hypoxemia

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Diagnosis

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  • Chest radiography

    • Heart size is usually normal in permeability edema

    • Heart size is usually enlarged in hydrostatic edema

    • Pulmonary vessels are prominent, often with diffuse interstitial or alveolar infiltrates

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Treatment

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  • Supplemental oxygen therapy and ventilator support may be indicated

  • Diuretics, digoxin, and vasodilators along with salt and water restriction may be indicated for heart failure

  • Loop diuretics, such as furosemide, are primarily beneficial because they increase systemic venous capacitance, not because they induce diuresis;improvement can even be seen in anuric patients.

  • Recommended interventions for pulmonary edema include reduction of vascular volume and maintenance of the lowest central venous or pulmonary arterial wedge pressure possible without sacrificing cardiac output or causing hypotension

  • β-Adrenergic agonists such as terbutaline have been shown to increase alveolar clearance of lung water, perhaps through the action of a sodium-potassium channel pump

  • Maintaining normal albumin levels and a hematocrit concentration above 30 maintains the filtration of lung liquid toward the capillaries

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