Symptoms and sensations of pulmonary edema. Symptoms, causes and treatment of pulmonary edema

Pulmonary edema is a condition in which fluid accumulates in the lungs instead of air, which leads to a sharp violation of gas exchange in the lungs and the development of hypoxia. Pulmonary edema is not an independent disease, but a disease that is a complication of other pathologies.

What causes pulmonary edema?

Causes of pulmonary edema can be of 2 types:

cardiogenic pulmonary edema - occurs with pathological overload of the heart, as well as with acute heart failure.

non-cardiogenic pulmonary edema - occurs in the lungs with myocardial infarction, with stagnation of blood in the vessels of the lung.

Non-cardiogenic causes of edema include respiratory diseases, such as pulmonary embolism, bronchial asthma. Complications after pneumonia in adults can also lead to pulmonary edema.

Other causes of pulmonary edema:

• chest trauma;
• In newborns, pulmonary edema may result from severe hypoxia;
• Chemical poisoning;
• drug use;
• Smoke inhalation;
• Uremia;
• Drowning;
• Cirrhosis of the liver.

Symptoms of pulmonary edema

Basically, pulmonary edema develops at night when a person is sleeping. A person wakes up and feels a strong suffocation. After some time, the patient develops a convulsive cough. Signs of pulmonary edema are as follows: at first, sputum of normal consistency appears, but with the progression of edema, it becomes more liquid, and subsequently turns into plain water.

With slowly developing pulmonary edema, a person is tormented by rapid breathing, which occurs without obvious reasons. Rapid breathing develops along with shortness of breath. First, it occurs during physical exertion, and then in a state of complete rest.

According to the flow, they distinguish:

Fulminant pulmonary edema - death occurs within a few minutes after the onset of edema.

Acute pulmonary edema (lasting up to 1 hour) - appears after a lot of stress or too much exercise

Prolonged pulmonary edema (duration 1-2 days) - develops with chronic inflammatory diseases of the lungs, chronic renal failure

Subacute - the symptoms of edema develop gradually, then increasing, then subsiding; it develops with acute liver or kidney failure, congenital heart defects.

Emotional stress, physical activity, the transition of a person from a vertical position to a horizontal one can provoke the development of edema.

The first symptoms of a beginning acute edema are: the appearance of pain in the chest, a feeling of squeezing it. Then it becomes difficult to inhale and exhale, shortness of breath increases.

Patients with suspected pulmonary edema must be hospitalized.

What to do with pulmonary edema before the ambulance arrives?

• If a person is conscious, he needs to be moved to an upright or sitting position.
• Provide access to fresh air
• The patient needs to put a nitroglycerin tablet under the tongue, if the tablet has resolved, but the condition has not improved, a second tablet should be given. You can take no more than 6 tablets per day.
• Unfasten the top buttons on the garment

The treatment for this disease depends on its severity and the cause. It is aimed at normalizing pressure in the pulmonary circulation, reducing peripheral vascular resistance, and correcting acid-base disorders.

Edema that has developed as a result of heart failure can be completely cured with the use of diuretics.

If the cause of pulmonary edema is an infection, antibiotics are used.

Particularly severe cases of pulmonary edema require the patient to be connected to a ventilator, which maintains his breathing at the proper level, while specialists take measures to treat and eliminate the underlying cause of the disease.

Prevention of edema is the timely treatment of those diseases that can lead to it.

Pulmonary edema

In pulmonary edema, fluid collects in spaces outside the pulmonary blood vessels. In one type of edema, the so-called cardiogenic pulmonary edema, fluid exudation is caused by an increase in pressure in the pulmonary veins and capillaries. Being a complication of heart disease, pulmonary edema can become chronic, but there is also acute pulmonary edema, which develops rapidly and can lead to the death of the patient in a short time.

What are the causes of pulmonary edema?

Pulmonary edema is usually caused by failure of the left ventricle, the main chamber of the heart, resulting from heart disease. In certain heart conditions, more pressure is required to fill the left ventricle to ensure sufficient blood flow to all parts of the body. Accordingly, the pressure in other chambers of the heart and in the pulmonary veins and capillaries rises. Gradually, part of the blood sweats into the spaces between the tissues of the lung. This prevents the lungs from expanding and disrupts the gas exchange taking place in them.

In addition to heart disease, there are other factors that predispose to pulmonary edema:

Excessive amount of blood in the veins;

Some kidney disease, extensive burns, diseased liver, nutritional deficiencies;

Violation of the outflow of lymph from the lungs, as is observed in Hodgkin's disease;

Decrease in blood flow from the left upper chamber of the heart (for example, with a narrowing of the mitral valve);

Disorders that cause blockage of the pulmonary veins.

What are the symptoms of pulmonary edema?

Early symptoms of pulmonary edema reflect poor lung expansion and transudate formation. These include:

Sudden attacks of respiratory distress after several hours of sleep;

Difficulty breathing, which is relieved by sitting;

Examination of the patient may reveal a rapid pulse, rapid breathing, abnormal sounds when listening, swelling of the jugular veins, and deviations from normal heart sounds.

With severe pulmonary edema, when the alveolar sacs and small airways are filled with fluid, the patient's condition worsens. Breathing quickens, becomes difficult, coughing up frothy sputum with traces of blood. The pulse speeds up, heart rhythms are disturbed, the skin becomes cold, clammy and takes on a bluish tint, sweating increases As the heart pumps less and less blood, blood pressure drops, the pulse becomes thready.

How is the disease diagnosed?

Diagnosis is based on symptoms and physical examination, followed by an arterial blood gas test, which usually shows a decrease in oxygen. At the same time, disturbances in the acid-base balance and acid-base balance, as well as metabolic acidosis, can also be detected.

Chest x-rays usually show diffuse opacification in the lungs and often cardiac hypertrophy and excess fluid in the lungs.

In some cases, pulmonary artery catheterization is used for diagnostic purposes, which allows confirming left ventricular failure and excluding adult respiratory distress syndrome, the symptoms of which are similar to those of pulmonary edema.

How is pulmonary edema treated?

Treatment is aimed at reducing the amount of fluid in the lungs, improving gas exchange and heart function, as well as treating the underlying disease.

As a rule, the patient is allowed to breathe mixtures with a high oxygen content. If an acceptable level of oxygen cannot be maintained, mechanical ventilation is used to improve tissue oxygen supply and restore acid-base balance.

The patient may also be prescribed diuretics (eg, Lasix) to remove fluid from the urine, which in turn helps to reduce the amount of extravascular fluid.

For the treatment of cardiac dysfunction, in some cases, digitalis glycosides and other arterial dilating agents (for example, niprid) are prescribed. Morphine can be used to relieve anxiety, ease breathing, and improve circulation.

Causes of pulmonary edema: prevent the development of a terrible disease!

Acute pulmonary insufficiency or pulmonary edema is a serious violation of gas exchange in the organs, as a result of the ingress of transudate from the capillaries into the lung tissue. That is, the liquid enters the lungs. Pulmonary edema is a pathological condition accompanied by an acute oxygen deficiency throughout the body.

Causes of pulmonary edema

Pulmonary edema is distinguished by causes and time of development

There are various forms of edema according to the causes of the development of the disease and the time of its development.

Species according to the speed of development

• Acute development. The disease manifests itself within 2-3 hours.
• Prolonged pulmonary edema. The illness lasts for a long time, sometimes a day or more.
• Lightning flow. It comes on completely suddenly. The lethal outcome, as an inevitability, comes in a few minutes.

There are a number of classic underlying causes of pulmonary edema.

So, non-cardiogenic edema is caused by various causes that are not related to cardiac activity. It could be liver disease. kidneys, poisoning with toxins, trauma.

Cardiogenic edema is caused by heart disease. Usually this type of disease occurs against the background of myocardial infarction, arrhythmias, heart defects, and circulatory disorders.

Predisposing factors

• Sepsis. The toxins then enter the bloodstream.
• Pneumonia based on various kinds of infections or injuries.
• Exceeding doses of certain medications.
• Radiation damage to organs.
• Drug overdose.
• Any heart disease, especially during their exacerbation.
• Frequent bouts of hypertension.
• Pulmonary diseases, for example, bronchial asthma, emphysema.
• Thrombophlebitis and varicose veins, accompanied by thromboembolism.
• A low level of protein in the blood, which manifests itself in cirrhosis of the liver or other pathologies of the liver and kidneys.
• A sudden change in air pressure when ascending to a great height.
• Exacerbation of hemorrhagic pancreatitis.
• Entry of a foreign body into the respiratory tract.

All these factors in total or one by one can be a strong impetus for the occurrence of pulmonary edema. If these diseases or conditions occur, it is necessary to monitor the patient's health status. Monitor his breathing and general vital activity.

From the proposed video, find out how we harm our lungs.

Diagnostics

To take the necessary first resuscitation measures and to treat the patient, a correct diagnosis of the disease is required.

During a visual examination during an attack of suffocation and pulmonary edema, it is necessary to pay attention to the appearance of the patient and the position of his body.

During an attack, excitement and fear are clearly distinguished. And noisy breathing with wheezing and whistling is clearly audible in the distance.

During the examination, pronounced tachycardia or bradycardia is observed, and the heart is poorly heard due to bubbling breathing.

ECG and pulse oximetry are often done in addition to routine examinations. Based on these methods of examination, the doctor makes a diagnosis.

On the electrocardiogram in case of pulmonary edema, a violation of the heart rhythm is recorded. And with the method of determining the saturation of blood with oxygen, a sharp decrease in the level of oxygen is distinguished.

A chest x-ray is required. In difficult cases, there is clouding in the picture, which indicates that the alveoli of the lungs are filled with fluid.

To determine the underlying cause of the disease, it is necessary to know the clinic of the disease. In some cases, a direct measurement of blood pressure in the vessels of the lungs is done. To do this, a special catheter is inserted into the large veins of the chest or neck, which makes it possible to determine the causes and degree of development of pulmonary edema with an accuracy of 99%.

Additional diagnostic methods

• Blood chemistry
• Ultrasound of the heart
• Coagulogram
• Echo KG
• Pulmonary artery catheterization

An experienced doctor, even a therapist, can diagnose and determine the severity of the condition without a complex examination:

• Dry skin - not a serious condition
• Forehead with slight perspiration - medium severity
• Wet chest is a serious condition
• Confusion and a completely wet body, including the chest and abdomen, is an extremely serious condition

If controversial issues arise, then consultations are held with a pulmonologist and a cardiologist, a council is created and a comprehensive decision is made on the treatment of the disease, as well as measures to prevent asphyxia.

Pulmonary edema: symptoms

Usually the disease develops suddenly, at night, often during sleep. If the attack is lightning-fast, which does not develop in stationary conditions, then it is impossible to save the patient without an emergency ambulance, since the protein-rich transudate forms whipped dense foam during the attack, which leads to a decrease in respiratory activity and oxygen starvation.

But this development of the disease is rare. More often, pulmonary edema develops gradually, sometimes with preceding signs.

Symptoms

Such symptoms may appear a couple of minutes before swelling or a few hours before.

The attack can be triggered by external factors

Stress, hypothermia, psycho-emotional overstrain, a sharp fall, physical activity can provoke an attack.

At the beginning of the attack, the resulting choking and coughing forces the patient to sit down or lie down. In this case, blue lips, nails, eyelids appear.

There is a nervous fever. and the skin takes on a gray tint. And cold sweat comes to the surface. There is a sign of mental excitement and motor restlessness.

Each time the attack is accompanied by an increase in blood pressure and tachycardia. During an attack, additional muscles are involved in breathing. Breathing quickens up to 30 times per minute. The shortness of breath increases, making it difficult to speak.

The patient's breathing becomes intensified, stridor, wheezing, without wheezing. Veins bulge in the neck. The face becomes puffy. When coughing, a pink foam is released. And the pulse during a cough sharply quickens, reaching up to 160 beats per minute.

In severe cases, confusion, coma is possible. The pulse becomes thready, and breathing is periodic, rare and shallow. With the development of asphyxia, a fatal outcome occurs.

If these symptoms occur, you should urgently seek emergency help by calling an ambulance. Only timely medical measures will help the patient avoid asphyxia and death. In such cases, you can not hesitate.

Consequences

The consequences of pulmonary edema can be different. If assistance is provided in a timely manner, qualified, then serious complications are not expected.

After pulmonary edema, a person may be disturbed by symptoms of pneumonia

Perhaps for some period there will be signs of congestive pneumonia, pneumofibrosis, pain in the heart. There is a possibility of developing chronic respiratory diseases.

However, often, despite the timely modern methods of treatment and diagnosis, in 50% of cases, pulmonary edema in combination with myocardial infarction is fatal.

In other cases of prolonged hypoxia, some irreversible processes occur in the nervous system and brain structure.

If there is damage to the central nervous system in the form of autonomic disorders, then there is no subject for special concern. In cases of brain destructuring, irreversible processes leading to the death of the patient are possible.

The earlier an attack of pulmonary insufficiency is stopped, the better the prognosis for the patient. In order to avoid serious consequences, it is necessary to follow the doctor's recommendations, follow diets, prevent contact with allergens, and give up bad habits, especially smoking.

Pulmonary edema: treatment

Treatment of a patient with pulmonary edema is carried out in a hospital in the intensive care unit. Treatment largely depends on the condition of the patient and his individual characteristics of the organism.

Principles of treatment

• Decreased excitability of breathing
• Increased contractions of the heart muscle
• Unloading blood circulation in a small circle
• Saturation of blood with oxygen - oxygen therapy - inhalation from a mixture of oxygen and alcohol
• Calming the nervous system with sedatives
• Removing fluid from the lungs using diuretics
• Treatment of the underlying disease
• Use of antibiotics in case of secondary infection
• The use of drugs that improve heart function

A wide range of drugs are used in the treatment of pulmonary edema.

In the conditions of inpatient treatment, the following drugs are used:

• Narcotic analgesics and neuroleptics, for example, Morphine, Fentanyl fractionally, intravenously.
• Diuretics, for example, Lasix, Furosemide.
• Cardiotonic glycosides, for example, Strofantin, Korglikon.
• Bronchial spasmolytics: Eufillin, Aminophylline.
• Hormonal preparations - glucocorticoids, for example Prednisolone intravenously.
• Antibiotic preparations of a wide spectrum of action. The most popular use is Ciprofloxatin and Imipenem.
• With a low level of protein in the blood, donor blood plasma is used infusionally.
• If the edema is caused by thromboembolism, Heparin must be used intravenously.
• With a decrease in blood pressure, Dobutamine or Dopamine is used.
• With a low heart rate, Atropine is used.

All doses and quantities of drugs for various purposes are prescribed to the patient individually. It all depends on the age of the patient and the specifics of the disease, on the state of the patient's immunity. Prior to medical appointment, these drugs should not be used, as this will aggravate the situation.

After removing the attack and restoring respiratory functions, it is possible to use treatment with folk remedies. Their use can be started after consultation with a doctor in the absence of his prohibition.

An effective method in such treatment is the use of decoctions, infusions and teas that give an expectorant effect. This will help to remove serous fluid from the body.

During treatment, it is necessary to direct actions to improve not only the physical and physiological condition of the patient. It is necessary to bring a person out of a stressful state, improving his emotional state.

Any treatment during pulmonary edema should be under the strict supervision of the attending physician. In the first period of therapy, all drugs are administered intravenously, since it is very difficult to take drugs orally.

Providing emergency care

There are a number of immediate measures to provide the very first aid to a person with pulmonary edema. Lack of such assistance can worsen the patient's condition.

First aid:

• It is necessary to give the patient a sitting position, while it is necessary to lower his legs to the floor.
• Organize direct access to fresh air, which will help breathing.
• Place your feet in hot water, foot baths will dilate the blood vessels.
• Allow the patient to breathe freely by removing tight and constricting clothing.
• Monitor breathing and pulse, measure blood pressure every 5 minutes.
• Let the patient inhale alcohol vapors.
• It is imperative to restore the mental and emotional state of the patient.
• At low pressure, give nitroglycerin.
• Apply venous tourniquets to the lower extremities.
• Provide access to a large vein upon the arrival of doctors.

First aid is needed before the ambulance arrives

These activities are carried out before the arrival of the ambulance. The emergency team, before a medical examination and diagnosis, takes some measures before arriving at the hospital. Usually this:

• Suction of foam and inhalation of alcohol vapors
• Withdrawal of excess liquid
• Pain relief for pain or shock
• Subcutaneous injection of camphor solution
• Using an oxygen bag to enrich breathing with oxygen
• bloodletting
• Pressure regulation

The remaining measures are carried out already in the hospital under the guidance of specialists.

After complete stabilization of the patient's condition, the treatment of the patient begins, which is aimed at eliminating the causes of edema.

Prevention of oxygen starvation is the primary task of doctors. Otherwise, the consequences of the attack will be irreversible.

The well-coordinated work of emergency workers and the correct actions of loved ones will help to avoid severe complications and consequences after an attack of respiratory failure.

Pulmonary edema: prognosis

The prognosis after pulmonary edema is not always favorable

It must be understood that the prognosis after suffering pulmonary edema is rarely favorable. The survival rate, as already mentioned, is no more than 50%.

At the same time, many have observed some deviations after treatment. If pulmonary edema occurred against the background of myocardial infarction, then mortality exceeds 90%.

In case of survival, more than a year should be observed by doctors. It is imperative to apply effective therapy to cure the underlying disease, due to which pulmonary edema occurred.

If the root cause is not eliminated, then there is a 100% chance of recurrence.

Any therapy is aimed at removing edema and preventing its recurrence.

Only correct and timely measures in treatment can give a favorable prognosis. Early pathogenetic therapy at the initial stage, timely detection of the underlying disease, and proper treatment will help to give a favorable prognosis for the outcome of the disease.

Prevention of pulmonary edema

Preventive measures in the fight against pulmonary edema is the timely treatment of diseases that cause edema. Eliminating the causes is prevention.

A healthy lifestyle, compliance with safety rules when working with harmful substances, poisons and toxins, compliance with the dosage of drugs, the absence of alcohol abuse. drugs and overeating are all preventive measures that will help to avoid attacks of pulmonary insufficiency.

In the presence of chronic diseases, with hypertension, all doctor's prescriptions should be followed in good faith.

An additional measure of prevention is maintaining a healthy lifestyle. proper nutrition and an active lifestyle.

It is impossible to guarantee that the moment of occurrence of an attack will be excluded, since it is impossible to make guaranteed insurance against infection or injury, but it is possible to reduce the risk of its onset. It should be remembered that prompt care for pulmonary edema is a life saved.6

- this is a serious pathological condition associated with a massive release of transudate of a non-inflammatory nature from the capillaries into the interstitium of the lungs, then into the alveoli. The process leads to a decrease in the functions of the alveoli and a violation of gas exchange, hypoxia develops. The gas composition of the blood changes significantly, the concentration of carbon dioxide increases. Along with hypoxia, severe depression of the central nervous system functions occurs. Exceeding the normal (physiological) level of interstitial fluid leads to edema.

The interstitium contains: lymphatic vessels, connective tissue elements, intercellular fluid, blood vessels. The entire system is covered by the visceral pleura. The branched hollow tubules and tubes are the complex that makes up the lungs. The entire complex is immersed in the interstitium. The interstitium is formed by plasma leaving the blood vessels. The plasma is then reabsorbed back into the lymphatic vessels that empty into the vena cava. According to this mechanism, the intercellular fluid delivers oxygen and essential nutrients to the cells, removes metabolic products.

Violation of the amount and outflow of interstitial fluid leads to pulmonary edema:

when an increase in hydrostatic pressure in the blood vessels of the lungs caused an increase in interstitial fluid, hydrostatic edema occurs;

the increase was due to excessive plasma filtration (for example: with the activity of inflammatory mediators), membrane edema occurs.

Condition assessment

Depending on the rate of transition of the interstitial stage of edema to the alveolar stage, the patient's condition is assessed. In the case of chronic diseases, edema develops more gradually, more often at night. Such edema is well stopped by drugs. Edema associated with defects in the mitral valve, damage to the lung parenchyma grows rapidly. The condition is rapidly deteriorating. Edema in its acute form leaves very little time to react.

Disease prognosis

The prognosis of pulmonary edema is unfavorable. It depends on the reasons that actually caused the swelling. If the edema is non-cardiogenic, it responds well to treatment. Cardiogenic edema is difficult to stop. After prolonged treatment after cardiogenic edema, the survival rate for a year is 50%. With a lightning-fast form, it is often not possible to save a person.

With toxic edema, the prognosis is very serious. Favorable prognosis when taking large doses of diuretics. It depends on the individual reaction of the body.

Diagnostics

The picture of any type of pulmonary edema is bright. Therefore, the diagnosis is simple. For adequate therapy, it is necessary to determine the causes that caused the edema. Symptoms depend on the form of edema. The lightning-fast form is characterized by rapidly increasing suffocation and respiratory arrest. The acute form has more pronounced symptoms, in contrast to the subacute and protracted.

The main symptoms of pulmonary edema include:

frequent coughing;

increasing hoarseness;

cyanosis (face and mucous membranes acquire a bluish tint);

increasing suffocation;

tightness in the chest, pain of a pressing nature;

By itself, pulmonary edema is a disease that does not occur on its own. Many pathologies can lead to edema, sometimes not at all associated with diseases of the bronchopulmonary and other systems.

Causes of pulmonary edema include:

Overdose of certain (NSAIDs, cytostatics) drugs;

Radiation damage to the lungs;

Overdose of narcotic substances;

Infusions in large volumes without forced diuresis;

Poisoning with toxic gases;

Aspiration of the stomach;

Shock with serious injuries;

enteropathy;

Being at high altitude;

There are two types of pulmonary edema: cardiogenic and non-cardiogenic. There is also a 3rd group of pulmonary edema (refers to non-cardiogenic) - toxic edema.

Cardiogenic edema (cardiac edema)

Cardiogenic edema is always caused by acute left ventricular failure, obligatory stagnation of blood in the lungs. Myocardial infarction, heart defects, arterial hypertension, left ventricular failure are the main causes of cardiogenic edema. To link pulmonary edema with chronic or acute, measure the capillary pressure of the lungs. In the case of a cardiogenic type of edema, the pressure rises above 30 mm Hg. Art. Cardiogenic edema provokes extravasation of fluid into the interstitial space, further into the alveoli. Attacks of interstitial edema are observed at night (paroxysmal dyspnea). The patient is out of breath. Auscultation determines hard breathing. Breathing is increased on exhalation. Choking is the main symptom of alveolar edema.

Cardiogenic edema is characterized by the following symptoms:

• growing cough;

  inspiratory dyspnea. The patient is characterized by a sitting position, in the prone position, shortness of breath increases;

  hyperhydration of tissues (swelling);

  dry whistling, turning into moist gurgling rales;

  separation of pink foamy sputum;

  acrocyanosis;

  unstable blood pressure. It's hard to bring it down. A decrease below normal can lead to bradycardia and death;

  severe pain behind the sternum or in the chest area;

  fear of death;

  On the electrocardiogram, hypertrophy of the left atrium and ventricle is read, sometimes blockade of the left leg of the His bundle.

Hemodynamic conditions of cardiogenic edema

violation of the systole of the left ventricle;

diastolic dysfunction;

systolic dysfunction.

The leading cause of cardiogenic edema is left ventricular dysfunction.

Cardiogenic edema should be differentiated from non-cardiogenic edema. With a non-cardiogenic form of edema, changes in the cardiogram are less pronounced. Cardiogenic edema proceeds more rapidly. Time for emergency care is less than with other types of edema. Lethal outcome is more often with cardiogenic edema.

Toxic edema has certain specific features that promote differentiation. There is a period here when there is no edema itself yet, there are only reflex reactions of the body to irritation. lung tissues, burns of the respiratory tract cause reflex spasm. This is a combination of symptoms of damage to the respiratory organs and the resorptive effects of toxic substances (poisons). Toxic edema can develop regardless of the dose of medication that caused it.

Medicines that can cause pulmonary edema:

narcotic analgesics;

many cytostatics;

diuretics;

radiopaque preparations;

non-steroidal anti-inflammatory drugs.

Risk factors for the occurrence of toxic edema are advanced age, prolonged smoking.

Has 2 forms developed and abortive. There is a so-called "silent" edema. It can be detected on x-ray examination of the lungs. A certain clinical picture in such edema is practically absent.

characterized by periodicity. Has 4 periods:

reflex disorders. It is characterized by symptoms of irritation of the mucous membranes: lacrimation, shortness of breath. The period is dangerous by stopping breathing and cardiac activity;

Latent period of subsidence of irritations. May last 4-24 hours. Characterized by clinical well-being. A thorough examination may show signs of impending edema: emphysema;

Direct pulmonary edema. The course is sometimes slow, up to 24 hours. Most often, the symptoms increase in 4-6 hours. During this period, the temperature rises, there is neutrophilic leukocytosis in the blood count, there is a danger of collapse. The advanced form of toxic edema has a fourth period of completed edema. The completed period has "blue hypoxemia". Cyanosis of the skin and mucous membranes. The completed period increases the respiratory rate to 50-60 times per minute. The bubbling breath is heard in the distance, sputum mixed with blood. Increases blood clotting. gaseous acidosis develops. "Gray" hypoxemia is characterized by a more severe course. Vascular complications join. The skin takes on a pale grayish tint. The limbs get cold. Thready pulse and falling to critical values ​​of arterial pressure. This condition is facilitated by physical activity or improper transportation of the patient;

Complications. When leaving the period of immediate pulmonary edema, there is a risk of developing secondary edema. It is associated with left ventricular failure. Pneumonia, pneumosclerosis, emphysema are common complications of drug-induced toxic edema. At the end of the 3rd week, "secondary" edema may occur against the background of acute heart failure. Rarely there is an exacerbation of latent tuberculosis and other chronic diseases. Depression, drowsiness, asthenia.

With rapid and effective therapy, a period of regression of edema occurs. It does not apply to the main periods of toxic edema. It all depends on the quality of the assistance provided. Cough and shortness of breath decrease, cyanosis decreases, wheezing in the lungs disappears. On x-ray, the disappearance of large, then small foci is noticeable. The picture of peripheral blood is normalized. The recovery period after toxic edema can be several weeks.

In rare cases, toxic edema can be caused by taking tocolytics. Edema can be catalyzed by: large volumes of intravenous fluid, recent treatment with glucocorticoids, multiple pregnancy, anemia, unstable hemodynamics in a woman.

Clinical manifestations of the disease:

The key symptom is respiratory failure;

severe shortness of breath;

• severe chest pain;

  Cyanosis of the skin and mucous membranes;

  Arterial hypotension in combination with tachycardia.

From cardiogenic edema, toxic edema differs in a protracted course and the content of a small amount of protein in the fluid. The size of the heart does not change (rarely changes). Venous pressure is often within the normal range.

Diagnosis of toxic edema is not difficult. An exception is bronchorrhea in case of FOS poisoning.

Occurs due to increased vascular permeability and high fluid filtration through the wall of the pulmonary capillaries. With a large amount of fluid, the work of blood vessels deteriorates. The fluid begins to fill the alveoli and gas exchange is disturbed.

Causes of non-cardiogenic edema:

renal artery stenosis;

pheochromocytoma;

massive renal failure, hyperalbuminemia;

exudative enteropathy;

pneumothorax can cause unilateral non-cardiogenic pulmonary edema;

severe attack of bronchial asthma;

inflammatory diseases of the lungs;

pneumosclerosis;

• aspiration of gastric contents;

  cancerous lymphangitis;

  shock, especially with sepsis, aspiration and pancreatic necrosis;

  cirrhosis of the liver;

  radiation;

  inhalation of toxic substances;

  large transfusions of drug solutions;

  in elderly patients who take acetylsalicylic acid preparations for a long time;

  drug addict.

For a clear distinction between edema, the following measures should be taken:

study the history of the patient;

apply methods of direct measurement of central hemodynamics;

radiography;

to assess the affected area in myocardial ischemia (enzyme tests, ECG).

For differentiation of non-cardiogenic edema, the main indicator will be the measurement of wedge pressure. Normal cardiac output, positive results of wedge pressure indicate a non-cardiogenic nature of the edema.

When the edema is stopped, it is too early to finish the treatment. After an extremely serious condition of pulmonary edema, serious complications often occur:

accession of a secondary infection. Most often it develops. Against the background of reduced immunity, it can even lead to adverse complications. Pneumonia against the background of pulmonary edema is difficult to treat;

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Pulmonary edema - a life-threatening pathology - requires the patient to be urgently hospitalized. This condition is characterized by overflow of the pulmonary capillaries, extravasation (exit) of fluid from the vessels into the alveoli and bronchi.

It happens that pulmonary edema appears at night when a person is sleeping (as a complication of the underlying disease) and during strong physical exertion.

A physical examination, including listening to the chest with a stethoscope, is a necessary first step. Abnormal lung sounds consistent with pulmonary edema are usually observed, although they may sometimes be obscured by the loudness of a heart murmur or other abnormal heart sound. If a cardiogenic cause is suspected, it is important to pay attention to heart sounds, although they may not always be present.

Video: pulmonary edema - when it occurs, diagnosis, clinic

To confirm and definitively diagnose pulmonary edema, a chest x-ray is usually taken. This will reveal any areas of fluid accumulation in the lungs. Abnormalities in the heart, which may be associated with underlying causes of pulmonary edema, may or may not be visible on a chest x-ray. For this reason, it is recommended that an echocardiogram be used for pets suspected of suffering from a cardiogenic cause.

Classification

Pulmonary edema as a complication occurs when there is a violation of the regulation of the amount of fluid entering and leaving the lungs. Simply put, with this complication, the lymphatic vessels do not have time to remove the excess blood filtered from the capillaries. And because of the increased pressure and low protein levels, there is a transition of fluid from the pulmonary capillaries to the alveoli of the lungs. That is, the lungs fill with fluid and cease to perform their functions. The causes of pulmonary edema are divided into two groups, with the main one in the first place - heart disease:

Any breed of dog or cat is equally susceptible to the effects of pulmonary edema. However, cats and dogs of breeds that are predisposed to specific, hereditary heart conditions are clearly at higher risk. The treatment of pets with pulmonary edema largely depends on its cause, since treatment of all underlying diseases is the mainstay of treatment in all cases. However, there is a comprehensive approach to treatment that includes a three-pronged strategy.

Patient stabilization: Most pulmonary artery patients end up in trouble. They are usually treated with oxygen therapy and medications to help them relax so they can properly oxygenate their tissues. Resolution of swelling: Treatment with diuretics and other drugs can help remove fluid from the lungs. Treat the root cause: This three-pronged approach always culminates in the treatment of the underlying disease. Without this step, there can be no long-term survival expectations. . When the cause of pulmonary edema cannot be isolated, or when it is considered incurable, there are nevertheless some well-established methods to help control fluid accumulation in the lung tissue.

• hydrostatic edema- occurs due to diseases in which intravascular hydrostatic pressure increases and fluid exits the vessel into the interstitial space, and then into the alveolus. The main cause of this edema is cardiovascular disease.
• membranous edema- occurs under the influence of toxins, while the walls of the capillary or alveoli are violated and the fluid enters the extravascular space.

There are two types of this complication: interstitial and alveolar. This, in fact, is the stages of the whole process, since the fluid overcomes two barriers (histohematic and histoalveolar). Comparative characteristics of both processes:

Diuretics are the mainstay of treatment in these cases, as are other drugs that help control other problems associated with the underlying condition. For example, most heart disease in pets is considered manageable but not curable. These chronic diseases may require long-term diuretic therapy along with any additional drugs to control the heart disease itself.

Symptoms of complications of pulmonary edema

The veterinary cost of pulmonary edema varies depending on the cost of treating the underlying disease. In general, however, treating an acute event is less expensive than long-term treatment for heart disease, which can cost hundreds of dollars per month in medication alone.

	interstitial	Alveolar
Symptoms of pulmonary edema	Shortness of breath, cough, no sputum	Cough, frothy sputum, wheezing (dry, then wet)
Liquid barrier	Histohematic (on the way blood-tissue)	Histoalveolar (on the way tissue-alveolus)
Characteristic	The fluid passes into the interstitial space from the vessel, only the lung parenchyma swells	Blood plasma, overcoming the wall of the alveolus, sweats into its cavity
without medical assistance. help with progression	Transforms into alveolar	Suffocation, death

Another classification is according to the severity of manifestations.

Causes and development

Cardiogenic - develops with acute left heart failure

The scheme of development of cardiogenic pulmonary edema

The cause of AHF (acute heart failure) can be:

Because many of its underlying causes are either inherited or traumatic, pulmonary edema is not usually considered preventable. However, many patients with underlying heart conditions can be successfully managed so that their conditions never progress to pulmonary edema.

Emergency management of dogs and cats with congestive heart failure. Association between hydration score and body weight change after fluid therapy in critically ill dogs and cats. Management of heart failure: treatment principles, therapeutic strategies and pharmacology. A textbook of canine and feline cardiology.

• pathology like atrial - mitral stenosis
• and the ventricle - myocardial infarction, hypertension, heart defects, resulting in a decrease in the contractile functions of the heart muscles.

With decompensated heart diseases, with stagnation in the pulmonary circulation (which also happens with bronchial asthma, pulmonary emphysema), in case of increased pressure in the capillaries and untimely medical care, pulmonary edema may develop.

Pulmonary edema, defined as excessive extravascular water in the lungs, is a common and serious clinical problem. Pulmonary edema can be life-threatening, but effective therapy is available to save patients from the harmful effects of lung imbalance, which can usually be identified and in many cases corrected. Because rational and effective therapy depends on understanding the basic principles of normal and abnormal fluid, solute, and protein transport in the lungs, this chapter begins with a brief overview of the major factors that regulate fluid and protein filtration in healthy lungs, before focusing on the pathophysiology of pulmonary edema.

In children, cases of cardiogenic pulmonary edema are extremely rare. The main reason for them is others: poisoning with harmful substances (for example, vapors of turpentine or kerosene), shock, inflammatory reactions, drowning.

Not cardiogenic

• As a result of other causes:
  • aspiration - getting into the lungs of foreign masses
  • traumatic - chest injury
  • shock - in all three cases, the pathology is associated with damage to the membrane
  • cancerous - the lymphatic system of the lungs is disturbed, that is, the outflow of fluid is difficult
  • neurogenic - here the causes of pulmonary edema lie in the central mechanisms, with intracranial hemorrhage, with severe convulsions or due to brain surgery, fluid may accumulate in the lungs.
• With a sharp ascent to high altitudes (3 km), high-altitude pulmonary edema may occur.
• ARDS - acute respiratory distress syndrome occurs with trauma, a serious infectious disease, inhalation of toxins, with pulmonary infections, while the integrity of the alveoli is violated, and the risk of fluid leaking from the vessels in them increases.
• With a sharp process of lung expansion, for example, with pneumothorax, with exudative pleurisy - in this case, edema usually occurs on one side of the lung - one-sided.
• Rare causes include pulmonary embolism, when a blood clot enters the vessels of the lung and clogs them.

Scientists have found that athletes who expose themselves to enormous physical exertion have a certain risk of getting pulmonary edema. These are athletes for marathon distances, freedivers, scuba divers, swimmers for long distances, climbers who climb to great heights. Moreover, some of them, after receiving the load, had mild edema, and in women this fact was detected more often than in men.

The chapter then discusses the diagnosis, treatment, and resolution of pulmonary edema. Chapters 6 and 9 also provide additional information on the regulation of fluid balance in the lungs, and Chapter 100 provides details on the onset and management of acute lung injury and acute respiratory distress syndrome, which are currently defined and subsequently discussed.

Pulmonary edema can be detected in adults on a chest x-ray when extravascular pulmonary water increases by about 35%. Although most radiographic features of pulmonary edema are nonspecific, improved radiographic techniques, combined with an improved understanding of the pathophysiology of pulmonary edema, increase the utility of the chest radiograph in the diagnosis of pulmonary edema.

Symptoms

A person subjectively feels the following symptoms of pulmonary edema.

In the initial stage (interstitial edema)	With progression (alveolar edema), already existing sensations are added
severe inspiratory dyspnea (difficulty inhaling) with rapid breathing at rest, that is, does not depend on physical activity increased sweating dry severe paroxysmal cough growing weakness increased heart rate the cough intensifies while lying down, so the person takes a forced position - the patient sits with his legs dangling anxiety	cough with a lot of pinkish frothy sputum breath at first wheezing, then bubbling, wheezing suffocation swollen neck veins acrocyanosis (outflow of blood from the extremities, they turn blue and become cold) possible fear of death

Attention! When the initial symptoms of pulmonary edema appear, it is important to provide qualified honey as soon as possible. help, so you should immediately call an ambulance.

Kerley's lines are interlobular sheets of abnormally thickened or expanded connective tissue that touch the x-ray. They are more accurately called partition lines. Thickened septal lines can arise from a variety of processes, including fibrosis, pigment deposition, and pulmonary hemosiderosis. However, when they are temporary, these lines are usually caused by swelling. These septal lines of edema are more clearly seen in older children and adults with chronic edema than in infants, presumably because they are wider.

Basic diagnostic methods

Collection of anamnesis	when interviewed, the doctor finds out the factors that contributed to pulmonary edema to select the correct treatment tactics. Heart diseases provoke cardiogenic edema, others mentioned above are not cardiogenic.
External review, in which the doctor reveals:	inspiratory dyspnea with retraction of the intercostal spaces during inspiration and supraclavicular fossae forced position of the patient cyanosis (blue) of the face and acrocyanosis (blue of the extremities) bulging veins in the neck cough dry or with phlegm wheezing heard in the distance profuse sweating
Auscultation (listening):	interstitial edema - hard breathing, tachycardia (increased heart rate), dry scattered, subsequently wheezing wheezes are determined alveolar edema - voiced crepitus, moist rales (starting from the base of the lungs, and then large bubbling over their entire surface), muffled heart tones, a gallop rhythm is auscultated (a heart rhythm that appears when the heart muscle is damaged), accent II tone over the pulmonary artery (this means increased oscillation of the cusps of the pulmonary artery due to increased pressure in the pulmonary circulation)
Percussion	a boxed tone of sound is determined, dullness over the posterior lower sections of the lungs, an increase in the borders of the liver.
Palpation	a weak, frequent pulse is detected, the filling of the cervical veins, the degree of moisture of the skin is determined.

An experienced doctor can easily determine the severity of the patient's condition by skin moisture:

Perivascular and peribronchial cuffs are also radiographic evidence of interstitial edematous fluid. For hydrostatic reasons, perivascular edema is greatest in gravity-dependent areas, so normal lung bridging is less in this region. Increased resistance in the vessels of the lower lobe contributes to the redistribution of blood to the upper lobes. This sign is of course of limited value in infants because they are more likely to be in the supine position, have less gravity induced differences due to their size, and usually have only a slight increase in lung arterial pressure compared to children and adults.

• mild - dry skin
• moderate - forehead with perspiration
• heavy - wet chest
• extremely severe - wet chest and abdomen

Additional diagnostic methods

• X-ray examination:
  • interstitial edema - blurred lung pattern, decreased transparency of the periradicular sections
  • alveolar edema - changes in the basal and basal sections in the form of a focal, diffuse (common) form or "butterfly wings".

• Electrocardiography - reveals signs of heart disease, as well as overload of its left side.
• Echo KG - is performed with a non-acute pulmonary edema to determine the concomitant disease that provoked this complication.
• Measurement of pulmonary capillary wedge pressure (hydrostatic pressure) using a catheter inserted into the pulmonary artery. This indicator is needed to make the correct diagnosis, since DZLK increases with cardiogenic edema, and remains the same with non-cardiogenic edema.
• Biochemical analysis of blood (transaminases) - also allows you to distinguish cardiogenic edema (transaminases are elevated) from non-cardiogenic (the indicator is normal).

Differential Diagnosis

Pulmonary edema is important to distinguish in time from bronchial asthma.

What are the consequences of pulmonary edema?

More severe forms of pulmonary edema usually cause percigar haze, presumably because large perivascular and peribronchial fluid collections are present at this location. A reticular or lattice pattern may also be present, which is more common in an upright person. Once the magnitude of pulmonary edema is severe enough to result in permanent airway occlusion or alveolar flooding, it is very difficult to separate edema, atelectasis, and inflammation on chest radiographs.

	Pulmonary edema	Bronchial asthma
Anamnesis	Most often cardiac	Allergic
Dyspnea	Inspiratory (difficulty inhaling)	Expiratory (difficulty exhaling)
Breath	Bubbling, wheezing, orthopnea	Wheezing with involvement of accessory muscles
Sputum	Foamy with a pinkish tint	Viscous, difficult to detach
Percussion	Sound with a boxy tone, dulling over some departments	Sound box
Auscultation	Harsh breathing, rales are moist, large bubbling	Expiration is prolonged, vesicular breathing with an abundance of whistling, buzzing dry rales
ECG	Overload of the left departments	Right heart changes

First aid for swelling

Before the arrival of the doctor, you can do it yourself:

• Give the patient a sitting position or half-sitting with legs down
• Provide reliable access to a large peripheral vein (for subsequent catheterization)
• Provide fresh air
• Let the patient inhale alcohol vapors (96% for adults, 30% for children)
• Take a hot foot bath
• Use venous tourniquets on the limb (from 30 minutes to 1 hour)
• Constantly monitor breathing and pulse
• In the presence of nitroglycerin and not low blood pressure - 1-2 tablets under the tongue.

Emergency care for pulmonary edema, provided by the ambulance team before arriving at the hospital, is as follows:

Air bronchograms indicate airless distal lung units rather than an underlying cause. Because pulmonary edema can lead to airway obstruction in children from both vagal reflex 27 and bronchial foam, airway closure can occur and air entrapment can occur. 29 Thus, low diaphragms may be a useful indicator of interstitial edema, provided there are no other causes of airway obstruction. Progressive recruitment of connective tissue spaces with edematous fluid in both cardiac and renal disease results in vaginal erosion, peribronchial cuffing, and a cloudy pattern of increased lung density.

• Oxygen therapy (active oxygen saturation)
• Foam suction and anti-foam therapy (oxygen inhalation through ethanol solution)
• Diuretic therapy (lasix, novurite) - removes excess fluid from the body, with low blood pressure, reduced doses of drugs are used
• In the presence of pain syndrome - taking painkillers (analgin, promedol)
• Other drugs depending on the level of blood pressure:
  • high - ganglion blockers (promote blood outflow from the heart and lungs and inflow to the extremities: benzohexonium, pentamine), vasodilators (expand blood vessels: nitroglycerin)
  • normal - reduced doses of vasodilators
  • low - inotropic agents (increase myocardial contractility: dobutamine, dopmin).

Treatment of pulmonary edema

In a hospital setting, therapy is continued.

Treatment of pulmonary edema

Pulmonary edema is characterized by the accumulation of fluid in the air spaces and interstitium of the lungs. This may be due to internal pathology of the lung or due to systemic factors. Hence, pulmonary edema has traditionally been classified into cardiogenic and non-cardiogenic causes. Cardiogenic pulmonary edema occurs due to acute left ventricular failure after a series of insults such as myocardial infarction. Non-cardiogenic pulmonary edema may be caused by acute lung injury or respiratory distress syndrome in adults.

• Oxygen therapy - inhalation of oxygen with ethyl alcohol to extinguish foam in the lungs
• Narcotic analgesics (painkillers) and antipsychotics (drugs to reduce psychomotor agitation): reduce hydrostatic pressure in the pulmonary vessels and reduce venous blood flow. Drugs: morphine, fentanyl
• Diuretics - reduce the volume of circulating blood, produce dehydration of the lungs: furosemide
• Cardiac glycosides (provide a cardiotonic effect): strophanthin, corglicon
• Other drugs for the treatment of pulmonary edema depending on the level of blood pressure (see above)
• Removal and prevention of bronchospasm: eufillin, aminophylline
• Glucocorticosteroids, surfactant therapy: used for non-cardiogenic pulmonary edema.
• In infectious diseases (pneumonia, sepsis) - broad-spectrum antibiotics.

Important to know: cardiac glycosides are mainly prescribed to patients with moderate congestive heart failure; glucocorticosteroids in cardiogenic pulmonary edema are contraindicated.

Cardiogenic pulmonary edema is caused by elevated pulmonary hydrostatic pressure secondary to elevated pulmonary venous pressure. Acute pulmonary edema is often the result of many ideas about coronary artery disease and its complications. The patient may have a massive myocardial infarction and subsequently develop papillary muscle dysfunction or a ventricular septal defect, which may help reduce left ventricular dysfunction and pulmonary edema. In addition, a patient with prior left ventricular dysfunction may have deterioration in left ventricular function with myocardial ischemia or infarction resulting in acute pulmonary edema.

Prevention

In chronic heart failure, ACE inhibitors (drugs to treat hypertension) are prescribed. With recurrent pulmonary edema, isolated blood ultrafiltration is used.

Also, prevention consists in avoiding factors that provoke pulmonary edema: timely treatment of heart diseases, lack of contact with toxic substances, adequate (not increased) physical and respiratory stress.

Although coronary artery disease is probably the most common etiology of acute cardiac decompensation with resulting pulmonary edema, other etiologies include aortic stenosis and diastolic dysfunction in hypertensive crisis. Pulmonary edema can be found at any age. However, the most common cause of pulmonary edema is cardiogenic. Cardiogenic pulmonary edema is caused by increased hydrostatic pressure in the capillaries of the lungs, which leads to fluid transudate in the interstitium and alveoli.

Is pulmonary edema treated with folk remedies?

Both left atrial deviation and left ventricular dysfunction can lead to cardiogenic pulmonary edema. On the other hand, permeability of pulmonary edema is a consequence of injury to capillary endothelial cells. Intravascular hydrostatic pressures are normal, but endothelial cells lose their integrity and no longer provide a semipermeable membrane. Most of these patients suffer from acute respiratory distress syndrome.

It can have various causes and consequences, it is a pathology that can result from diseases of the heart, liver and kidneys. What processes occur in the body with swelling? Briefly, they can be described as follows:

Mechanisms of development and causes of the syndrome

The pathogenesis of pulmonary edema depends on the disease that caused it. There are 3 mechanisms by which puffiness can develop:

Symptoms

As a rule, the symptoms of the disease appear when a person is in a supine position. How to determine that pulmonary edema begins? Usually these signs are:

Factors causing the development of edema

The causes of pulmonary edema are quite varied. Swelling may occur due to:

Pulmonary edema can be affected by the progression of diseases such as:

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The development of edema in infants

What causes swelling in young children who have not yet undergone provoking diseases? Pulmonary edema in infants has a special pathogenesis. The cause of the development of the syndrome in newborns can be:

Types of swelling depending on the cause

All pulmonary edema can be conditionally divided into groups depending on the cause of their development. There are 2 types of edema:

• cardiogenic (cardiac). During it, left ventricular failure develops, and stagnation of blood in the lungs also occurs. To determine that edema has occurred due to heart disease, it is necessary to measure the capillary pressure of the lungs. It must exceed 30 mmHg.
  

  Since cardiogenic edema proceeds very quickly, it often causes sudden death of a person.

• non-cardiogenic. It happens less often. There are 8 subspecies (Table 1).

Table 1 - Types of non-cardiogenic edema and their causes

subspecies name	Causes and manifestations
Shock	Congestion forms in the blood vessels connecting the heart and lungs. This is due to the deterioration of the left ventricle against the background of a state of shock. As a result, intravascular hydrostatic pressure increases, and part of the edematous fluid flows from the vessels into the lung tissues.
Cancer	It develops in people who have a malignant formation in the lungs. In this disease, the lymph nodes do not perform their functions (do not remove excess fluid from the lungs) properly. This causes blockage of the lymph nodes. As a result, transudate begins to accumulate in the alveoli.
high-altitude	It develops during the ascent to a hill. This edema is characterized by high pressure in the vessels, as well as capillary permeability, which occurs due to oxygen starvation. This edema is extremely rare.
Toxic	First, an adult begins to cough, he has a feeling of shortness of breath, lacrimation occurs. All this is due to the fact that toxic gases or vapors have entered the lower respiratory tract. This subspecies of edema is very difficult, a lethal outcome is possible against the background of it. This is due to the fact that due to the inhalation of toxic fumes, the medulla oblongata begins to work worse and subsequently the heart or breathing may stop.
Traumatic	It develops due to defects in the membrane covering the lung. Usually this edema develops against the background of a disease such as pneumothorax. During it, the capillaries located next to the alveoli are damaged. As a result, red blood cells, as well as the liquid part of the blood, enter the alveoli.
Allergic	It develops in people who have hypersensitivity to any allergens. So, it can occur due to the bite of wasps or bees. In addition, pulmonary edema can also occur during blood transfusion. With such edema, the allergen must be removed from the human body immediately. Otherwise, anaphylactic shock may occur, which will certainly cause death.
neurogenic	During it, spasms occur in the veins. Due to the violation of the innervation of the respiratory vessels, the hydrostatic pressure in the intravascular space increases. Then the plasma begins to flow out of the bloodstream. First it enters the interstitium, and then into the alveoli
aspiration	If the contents of the stomach enter the bronchi, then there will be an obstruction of the airways. It will also increase the permeability of the smallest blood vessels. From them, the plasma will begin to flow into the pulmonary alveoli

Possible risks of edema development

Pulmonary edema in adults and children requires emergency medical intervention. If help is not provided to the patient on time, then pulmonary edema can cause many negative consequences that threaten the life of the patient.

The development of the syndrome can lead to:

Pulmonary edema can also cause:

• ischemic damage to various organs, as well as body systems;
• development of bronchitis or pneumonia;
• violation of the blood circulation of the brain;
• segmental atelectasis;
• heart failure;
• pneumofibrosis;
• cardiosclerosis.

How pulmonary edema will proceed and whether there will be negative consequences for the health and life of a person depends on the reasons by which it is caused. However, it is possible to cope with this pathology, but only with the timely help of specialists.

Respiratory function in bedridden patients is at risk, in particular due to the fact that a person is always lying down, which reduces the circulation of fluids in the body, causing. A weakened body, susceptibility to infectious diseases and stagnation in the pulmonary circulation can lead to serious consequences. In patients with unstable hemodynamics, pulmonary edema is one of the most frequent complications, and the sooner the necessary assistance is provided to a person, the less the body will suffer from such a pathological process.

Disease classification

The human pulmonary system is a complex and precise mechanism, consisting of several systems that fully complement and compensate for each other's work. Adequate gas exchange in the lungs occurs with the participation of the alveoli and the smallest capillaries. Violation of the permeability of the walls of the capillaries, stagnation in the pulmonary circulation, constant lying position in humans and edema (positive hydrobalance of the body) become factors leading to such a complication.

Pulmonary edema is classified according to the mechanism of development:

• hydrostatic edema. It is formed with an increase in pressure in the pulmonary circulation. Under the influence of increasing pressure, edema develops, pressing on the walls of the capillaries, due to which excess fluid gradually seeps into the alveoli. Most often, hydrostatic edema is caused by heart disease, and in particular heart failure.
• membranous edema. Against the background of the infectious process in the blood there is a large amount of toxins secreted by microorganisms. Such toxic substances have a strong destructive effect on the walls of small vessels and capillaries, which leads to leakage of fluid into the alveoli. The more intense the infectious process, the more likely it is that pulmonary edema will soon occur in bedridden patients.

One of the triggering factors for the formation of edema is the very fact that a person is weakened and is in a supine position. This leads to shallow breathing, in which not all lobes of the lungs participate. The weakening of breathing contributes to the development of edema of the alveoli, which are not involved in the act of breathing. Moreover, any processes, such as pneumonia, heart disease or infectious diseases, can give a powerful impetus to the development of edema in bedridden patients.

Symptoms of the disease

Pulmonary edema in bedridden patients often develops gradually, even over several days, the fluid gradually accumulates and makes it difficult for a person to breathe. But there are various situations depending on the root cause of the formation of edema. There are 3 stages in the development of the disease. They differ in the rate of increase in swelling and symptoms. The faster the edema develops, the brighter and clearer the symptomatic picture in the patient will be.

1 stage:lightning fast	2 stage:acute	3 stage:protracted
The increase in edema occurs so rapidly that, as a rule, it is a complete surprise and shock for the patient. This stage has the most negative effect on the body, because capillaries are traumatized, which increases the rate of growth of fluid and blood into the alveoli.	The increase in edema occurs within 3-4 hours. Symptoms increase gradually and often do not immediately begin to disturb the patient	This stage is the most invisible. Edema grows so slowly that a person simply does not notice it. Stage 3 is also the easiest to treat with drug therapy.

Symptoms of pulmonary edema in bedridden patients are not very diverse, therefore, for example, the protracted stage is the most difficult to detect. Since the main system affected is the lungs, the symptomatic picture is expressed by the insufficiency of the respiratory function, but there are also changes in other body systems, namely:

• Increasing rales in the lungs. It develops when fluid in the lungs of a bedridden patient accumulates in such an amount that with each inhalation and exhalation, wheezing will be heard at a distance from the person. The stronger the swelling, the stronger the wheezing in the patient will be heard.
• Difficulty breathing. A person has a feeling of lack of air, due to a decrease in the lung tissue involved in the act of breathing.
• Bloody foaming sputum. With each breath, there is an increase in the release of blood through the smallest capillaries into the alveoli. Mixing with the liquid, it forms a bloody foamy sputum, which is one of the brightest and most reliable symptoms of edema.
• Blueness of the skin. Since not all lung tissue is involved in breathing due to edema, the supply of oxygen to the body is sharply reduced. This causes hypoxia and, as a result, cyanosis (cyanosis). The stronger and longer the hypoxia, the stronger it affects the brain, the metabolic processes of which are impossible with a low level of oxygen in the blood.
• Drop in blood pressure. With a small loss of blood, there will be no strong damage to blood pressure, but if the volumes are significant, then the numbers on the tonometer can drop to 80-90 mm Hg.
• General weakness and fatigue. Pulmonary edema in bedridden patients greatly debilitates the body, as there is a disorder of the most important system - respiration. Coupled with low blood pressure, a person feels severe weakness and drowsiness.

The symptomatic picture of pulmonary edema depends on the rate of fluid buildup. But since the body of a bedridden patient is already subject to serious stresses and changes, one or two symptoms are often present, no more. Therefore, it is important to understand how pulmonary edema occurs in bedridden patients and to know what to do in such situations.

First aid and treatment of pulmonary edema

Video

Pulmonary edema is a rather serious condition in which the transudate leaves the capillaries and enters the tissues of the lung and alveoli. This process leads to a decrease in the function of the alveoli, as well as a violation of normal gas exchange and oxygen starvation. Against this background, the composition of the blood changes significantly, the concentration of carbon dioxide in it increases. This pathological process is accompanied by severe depression of the central nervous system. The accumulation of excess interstitial fluid leads to edema. Pulmonary edema often causes death in people of all ages. The prognosis depends on the speed of providing first aid to the patient.

General description of pathology

The development of the primary mechanism of edema is very complex. The interstitium consists of lymphatic vessels, connective tissue, blood vessels, and interstitial fluid. The whole complex is opened by a special visceral pleura. An extensive branching of the hollow tubules makes up the lungs. The entire system of the respiratory organ is immersed in the interstitium. This substance is formed by the plasma that comes out of the blood vessels. After that, the plasma is absorbed again into the lymphatic vessels, which are connected to the vena cava. Thanks to this complex process, the liquid supplies oxygen and the necessary nutrients to the cells and removes metabolic products from them.

If the volume of the intercellular fluid or its outflow is disturbed, then pulmonary edema develops in such cases:

• If a significant increase in hydrostatic pressure in the vessels led to an increase in interstitial fluid. In this case, doctors talk about hydrostatic edema.
• If the fluid increase is due to excessive plasma filtration. In this case, we speak of membranous edema.

Pulmonary edema is a life-threatening condition that requires emergency medical attention. This pathology is easier on the background of chronic diseases and most often occurs at night. This form of the disease responds well to drug treatment.

Pulmonary edema in heart disease develops rapidly, the patient's condition worsens very quickly and there is very little time for first aid.

With a lightning-fast form of cardiogenic edema, it is often impossible to save the patient.

Causes

There are many reasons for the occurrence of pathology. Pulmonary edema cannot be considered an isolated disease. This is just a complication of some pathological process in the body. The cause of acute pulmonary edema can be:

• Diseases that are accompanied by the ingestion of toxins of a different nature into the blood. This is observed with sepsis and pneumonia, as well as with an overdose of certain drugs and drugs, such as heroin and cocaine. Radiation damage to the lung tissue also leads to edema. Toxins greatly disrupt the structure of the membrane, due to this, its permeability increases significantly, and the liquid from small capillaries goes beyond the vessels.
• Pathologies of the heart in the stage of decompensation, which are accompanied by insufficiency of the left ventricle of the heart and a significant congestion in the pulmonary circulation. This is typical for a heart attack and severe heart defects.
• Diseases of the lungs that lead to congestion in the right circulation. These pathologies include bronchial asthma and emphysema.
• Thromboembolism of the pulmonary artery. This phenomenon occurs with a tendency to the appearance of blood clots. The risk group includes patients with hypertension and varicose veins. In such patients, a thrombus may form, which then detaches from the vascular wall and migrates throughout the body with the bloodstream. Once in the pulmonary artery, a thrombus clogs it. This leads to a strong increase in pressure in the vessel and the capillaries extending from it. In these vessels, fluid pressure increases, which ultimately leads to the accumulation of excess fluid in the lungs.
• Pathologies that are accompanied by a decrease in the level of protein in the blood. This includes severe liver and kidney disease. In patients with cirrhosis of the liver or nephritis, oncotic pressure in the blood decreases, which leads to pulmonary edema.
• A large volume of fluid that is infused intravenously can also cause pulmonary edema. This occurs if forced diuresis is not performed simultaneously with the infusion. Due to this, the hydrostatic pressure of the blood increases, which leads to a serious condition.

In adults, pulmonary edema is diagnosed much more often than in children.. At the same time, the risk of developing such a pathology in an elderly person is much higher than in young people.

Athletes who train for wear are at greater risk of developing pulmonary edema. Some athletes have mild edema after hard training, female athletes suffer from this ailment more often than men.

Clinical picture

Symptoms of pulmonary edema most often appear suddenly and increase very rapidly. The symptomatology depends entirely on the stage of the disease. The clinical picture of the interstitial and alveolar stages of pulmonary edema is very different.

According to the degree of progression of the main symptoms, the following forms of pulmonary edema are divided:

• Acute. Symptoms of alveolar edema appear several hours after signs of interstitial edema appear. This form of pathology is most often diagnosed in the adult population. The cause may be heart disease, which occurs due to severe stress or active physical activity. The acute form of pulmonary edema often accompanies myocardial infarction.
• Subacute. It lasts from 4 to 12 hours. Occurs due to fluid retention, mainly in renal or hepatic insufficiency. It happens with congenital heart disease and anomalies of large vessels. Often occurs when lung tissue is damaged by toxins or infections.
• Protracted. It may last a day or more. It happens with chronic kidney failure, inflammatory lung diseases and some systemic pathologies of connective tissues.
• Lightning. Just a few minutes after the onset of the pathological process, a person dies. This pulmonary edema is the most common cause of death in myocardial infarction and anaphylactic shock.

Against the background of chronic diseases, pulmonary edema often begins at night. This is due to the long horizontal position of a person. If a blood clot has become the cause of fluid accumulation, a person’s condition can worsen dramatically at different times of the day. Pulmonary edema in the elderly is particularly severe and often leads to serious consequences.

The main signs of pulmonary edema are quite specific and look like this:

• Severe shortness of breath is observed even in a state of complete rest. The patient's breathing is loud, bubbling, but quite frequent. You can hear how the patient breathes, even at a distance of several meters.
• Attacks of severe suffocation occur sharply. The patient feels an acute lack of air, this is especially noticeable in the supine position. In this case, a person takes a semi-sitting position of the body, in which it is easier for him to breathe.
• The lack of oxygen leads to severe, pressing pain in the chest.
• The work of the heart is severely disturbed, markedly rapid heartbeat.
• There is a cough with strong wheezing, which can be heard even at a distance. When coughing, pink foam comes out profusely.
• On examination, the patient may notice abnormal pallor and cyanosis of the skin. The person sweats profusely, and the sweat is cold and clammy. All these phenomena are associated with circulatory disorders.

In addition to these signs, there is confusion. A person first becomes overly excited, he is haunted by fears of death. As the disease progresses, arousal turns into lethargy and, as a result, a person may fall into a coma.

Mortality from pulmonary edema is very high. The prognosis depends on the form of edema and the speed of providing the patient with the necessary assistance. At the first symptoms of the disease, you need to urgently call a doctor.

Diagnostics

Symptoms of pulmonary edema are very specific, but they do not always appear in a timely manner and in full, so diagnosis can be very difficult. If the patient is fully conscious, then the doctor listens to complaints and collects an anamnesis. Thanks to these data, it is possible to determine the root cause of such a pathology and try to eliminate it.

If the patient is unconscious, then a presumptive diagnosis is made on the basis of an examination of the person. According to the results of the examination, the doctor can suggest the causes of such a pathological condition.

When examining a patient, a specialist pays attention to the pallor and cyanosis of the skin. Too pulsating jugular veins and superficial, rapid breathing should alert the doctor.

The patient's pulse is weak and thready. The doctor may note the viscous cold sweat that covers the patient's body. When tapping the lung area, there is some dullness of sound above the respiratory organs. This indicates a high density of lung tissue. When listening to the lungs with a stethoscope, you can hear hard breathing, which is accompanied by wheezing. The pressure in such a pathology can rise greatly.

To clarify the diagnosis, a number of laboratory tests are required:

• A general blood test - using this analysis, you can see if there is an infectious process in the body.
• Biochemical blood test - helps to determine the causes of pulmonary edema. Based on the results of this analysis, it is easy to differentiate cardiac causes from other causes that were triggered by a decrease in protein in the blood. If, according to the results of such an analysis, it is clear that the level of urea and creatinine is increased, then we can talk about the pathology of the kidneys, which caused the edema of the respiratory organs.
• Blood clotting test. Indicates edema that has arisen due to thromboembolism of the pulmonary artery.

The patient must be assigned an analysis for the study of the gas composition of the blood. If, according to the results of the analysis, an increase in carbon dioxide in the blood is noticeable, then pulmonary edema can be suspected.

Some instrumental diagnostic methods are assigned, these include:

• Determination of the level of oxygen saturation of the patient's blood. With edema, this figure does not exceed 90%.
• Measurement of central venous pressure.
• Electrocardiogram. Allows you to determine the violations of the heart.
• Ultrasound of the heart helps to clarify the causes of pathological changes that were identified by the ECG.

The patient must be sent for a chest x-ray. This study allows you to confirm or disprove the presence of fluid in the lungs. Pathology can be determined by unilateral or bilateral darkening, and if the edema is caused by a cardiac cause, then an enlarged shadow of the heart can be seen in the picture.

Sometimes narrow specialists are also involved to clarify the diagnosis and prescribe treatment. It can be a cardiologist and an infectious disease specialist.

Treatment

Treatment is carried out only in a hospital. If the patient's condition is too severe, then he is immediately placed in the intensive care unit.

If a person has signs of pulmonary edema, it is urgent to call an ambulance team. Even in the process of transportation, the patient is given first aid according to the approved protocol. Emergency care includes the following activities:

• The patient is comfortably placed half-sitting. In this position, breathing is greatly facilitated.
• According to the indications, oxygen therapy is carried out. If breathing is very difficult, then tracheal intubation is performed and then artificial ventilation is performed.
• In the clinical recommendations for first aid, it is mandatory for patients to resorb nitroglycerin tablets.
• If necessary, the patient is injected with morphine, for pain relief.
• Venous tourniquets are applied to the patient's legs to reduce blood flow to the right side of the heart and prevent an increase in pressure in the small circulatory system. When applying bandages, you need to make sure that the pulse on the limbs is palpable.

Tourniquets can be applied for no more than 20 minutes. Remove the tourniquets after gradual loosening.

Further treatment of pulmonary edema is carried out in the intensive care unit or intensive care unit. Health workers around the clock monitor the pressure, as well as cardiac and respiratory activity in such patients. Medicines are given intravenously, most often into a subclavian vein into which a catheter is inserted. In the treatment of this pathology, drugs of the following groups can be used:

• Defoamers are often used for pulmonary edema. They consist of pure oxygen and ethyl alcohol vapor.
• If the pressure is elevated and there are signs of myocardial damage, nitroglycerin is prescribed.
• Diuretic drugs or diuretics, for the rapid removal of excess fluid from the body.
• Drugs to increase heart contractions.
• If severe pain worries, morphine-based drugs are prescribed.
• If there are signs of thromboembolism, then anticoagulants are prescribed.
• If the work of the heart is too slow, they are prescribed.
• With symptoms of bronchospasm, hormonal agents are indicated.
• If some kind of infection has become the cause of the edema, then drugs with a large spectrum of action are prescribed.

In some cases, transfusion of blood or fresh frozen plasma is indicated. The duration of treatment for such a pathology can vary significantly. It depends on the severity of the patient's condition and the age of the patient.

Pulmonary edema is treated only in a hospital. Treatment at home is not carried out! Only emergency care can be provided to the patient at home.

Forecast

It is difficult to predict anything with pulmonary edema. The prognosis mainly depends on the cause that provoked the pathology. If the accumulation of fluid is not associated with heart disease, then the prognosis is most often good. The cardiogenic form is difficult to stop, therefore, in this case, mortality is higher. The consequences of cardiogenic pulmonary edema in the elderly are especially sad. Survival throughout the year is only 50%.

The most difficult prognosis for the toxic form of pathology. In this case, recovery is possible only with the introduction of a high dose of diuretics, although a lot depends on the endurance of the patient's body.

Sometimes it is quite possible and necessary to prevent this pathology, since the consequences of cardiogenic pulmonary edema are not always favorable. Prevention includes early detection and treatment of pathologies. Which can lead to excessive accumulation of fluid in the body. If there are dangerous signs of pulmonary pathology, you should immediately call an ambulance.