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3.6.6 - Pulmonary Oedema

from Section 3.6 - Acute Respiratory Failure

Published online by Cambridge University Press:  27 July 2023

Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Pulmonary oedema occurs when pulmonary capillary membrane permeability or hydrostatic pressure is increased.

  2. 2. Pulmonary oedema is categorised as either cardiogenic or non-cardiogenic, and early diagnosis of the underlying cause is key.

  3. 3. Patients with cardiogenic pulmonary oedema secondary to acute heart failure are often hypovolaemic/euvolaemic, and treatment with diuretics is associated with increased mortality, myocardial infarction and the need for mechanical ventilation. Vasodilators and prompt consideration of non-invasive ventilation are advised.

  4. 4. In patients with cardiogenic shock secondary to chronic decompensated heart failure, diuresis and prompt consideration of non-invasive ventilation are advised.

  5. 5. In patients with non-cardiogenic pulmonary oedema, the role of non-invasive ventilation is less clear and early endotracheal intubation should be considered.

Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
, pp. 238 - 241
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Gandhi, SK, Powers, JC, Nomeir, AM, et al. The pathogenesis of acute pulmonary oedema associated with hypertension. N Engl J Med 2001;344:1722.CrossRefGoogle ScholarPubMed
Griffiths, MJD, McAuley, DF, Perkins, GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res 2019;6:e000420.CrossRefGoogle ScholarPubMed
Patel, BK, Wolfe, KS, Pohlman, AS, Hall, JB, Kress, JP. Effect of non-invasive ventilation delivered by helmet vs facemask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomised clinical trial. JAMA 2016;14:2435–41.Google Scholar
Ponikowski, P, Voors, AA, Ankers, SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37;2129–200.CrossRefGoogle Scholar
Vital, FMR, Ladeira, MT, Atallah, AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema). Cochrane Database Syst Rev 2013;5:CD005351.Google Scholar
Ware, LB, Matthay, MA. Acute pulmonary oedema. N Engl J Med 2005;353:2788–96.CrossRefGoogle Scholar

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