Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ 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 +++ Clinical Findings ++ 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 +++ Diagnosis ++ 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 +++ Treatment ++ 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 Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.