Acute pulmonary edema

Introduction to acute pulmonary edema Acute pulmonary edema is one of the emergency departments of cardiology. The main clinical manifestations are: sudden severe breathing difficulties, sitting breathing, coughing, often coughing out pink foamy sputum, patients irritability, cyanotic lips, sweating, The heart rate increases, the two lungs are covered with wet rales and wheezing sounds, and severe cases can cause syncope and cardiac arrest. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: multiple system organ failure

Causes of acute pulmonary edema

Excessive heart load ( 20 %):

Acute cardiac volume overload, such as acute myocardial infarction or infective endocarditis, cardiac trauma, etc. caused by heart valve damage, chordae rupture, papillary muscle dysfunction, ventricular septal perforation, etc., in addition to intravenous blood transfusion, infusion too much too fast It can also cause acute pulmonary edema.

Myocardial contractility is reduced (30%):

Acute diffuse damage of the myocardium leads to weakened myocardial contractility, such as acute extensive myocardial infarction and acute myocarditis.

Cardiac pressure load (30%):

Acute mechanical obstruction causes excessive cardiac stress and obstruction of blood discharge, such as severe hypertension, aortic stenosis or mitral stenosis.

Ventricular diastolic restriction ( 10 %):

Acute ventricular diastolic restriction, such as acute cardiac tamponade caused by acute massive pericardial effusion, leads to decreased cardiac output and systemic congestion.

Other (10%):

Increased tissue metabolism and circulatory acceleration such as hyperthyroidism, severe anemia, etc.

Acute pulmonary edema prevention

The corresponding measures are given in time for the cause or cause.

Controlling infusion rate and infusion type: Infusion rate too fast and excessive input of crystalloid are the most common causes of pulmonary edema in anesthesia, especially in the elderly, infants and patients with poor cardiac function. Intraoperative application of central venous pressure monitoring to guide infusion and blood transfusion.

Smooth airway and respiratory support: Keep the airway open, prevent excessive secretions from the respiratory tract, vomiting, reflux, and aspiration, to avoid airway obstruction and throat and bronchospasm.

Acute pulmonary edema complications Complications, multiple system organ failure

Acute pulmonary edema can be complicated by DIC, acid-base balance disorders, and various systemic phases of various organs are damaged, eventually leading to multiple organ failure.

Symptoms of acute pulmonary edema Common symptoms Dyspnea blood pressure drop Chest tightness with high blood pressure chest tightness Xenon lungs can smell and dry and dry... Pink foam mixed acid-base balance disorder cold sweat

According to the process of edema development, it is divided into pulmonary interstitial edema and alveolar edema.

Pulmonary interstitial edema

Symptoms: Patients often feel chest tightness, fear, cough, and difficulty breathing.

Signs: pale, rapid breathing, tachycardia, elevated blood pressure, can be heard and wheezing.

X-ray examination: the pulmonary vascular texture is blurred and the hilar shadow is unclear. The lobular lobe is widened to form the Kerley A and B lines.

Blood gas analysis: PaCO2 is low, pH is low, and it is respiratory alkali poisoning.

Alveolar edema

Symptoms: The patient's face is paler, more difficult to breathe, and cold sweat.

Signs: lips, nail bed purple, a lot of pink foam sputum, general anesthesia patients can show increased respiratory resistance and cyanosis, a large number of pink foam sputum through the tracheal tube; double lung auscultation: full lung wet rales, blood pressure drop

X-ray examination: mainly alveolar dense shadows, which are merged into irregular flaky shadows, diffusely distributed or confined to one side or one leaf, or seen on both sides of the hilum, gradually fade from the inside to the outside, forming a so-called butterfly Typical.

Blood gas analysis: PaCO2 is high and / or PaO2 is decreased, pH is low, showing hypoxemia and respiratory acidosis.

Examination of acute pulmonary edema

Pulmonary interstitial edema

X-ray examination: the pulmonary vascular texture is blurred and the hilar shadow is unclear. The lobular lobe is widened to form the Kerley A and B lines.

Blood gas analysis: PaCO2 is low, pH is low, and it is respiratory alkali poisoning.

Alveolar edema

X-ray examination: mainly alveolar dense shadows, which are fused with irregular flaky shadows, diffusely distributed or confined to one side or one leaf, or seen on both sides of the hilum, gradually fade from the inside to the outside, forming a so-called butterfly Typical.

Blood gas analysis: PaCO2 is high and / or PaO2 is decreased, pH is low, manifested as hypoxemia and respiratory acidosis.

Diagnosis and differentiation of acute pulmonary edema

The diagnosis of pulmonary edema is based on symptoms, signs and X-ray findings. The chest basic impedance (thoracic fluid index, TFl) is continuously measured, and the decrease in TFI reveals an increase in lung water.

Early diagnosis: Determination of pulmonary arteriolar wedge pressure and plasma colloid osmotic pressure, such as pulmonary edema inevitable when the pressure difference is less than 4mmHg.

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