Pulmonary edema is a pathological condition caused by the penetration of non-inflammatory fluid from the pulmonary capillaries into the interstitium and alveoli. Because of this, there is a sharp violation of gas exchange, oxygen starvation begins, exhausting tissues and organs.
Types of pulmonary edema
OL is a condition in which help should be given immediately. It can arise as a result of physical exertion, and at night - at rest. Sometimes pulmonary edema becomes a complication, which develops against the background of a violation of the circulation of fluid in the organ. Vessels do not cope with the excess of blood filtered from the capillaries, and the liquid under high pressure passes into the alveoli. Because of this, the lungs stop correctly performing their basic functions.
The development of OL occurs in two phases. First the blood penetrates into the interstitium. This condition is called interstitial pulmonary edema. With it, the parenchyma is completely impregnated with liquid, but the lumen of the alveoli does not enter the transudate. From the interstitial space, if the pressure does not decrease, the blood mass penetrates into the alveoli. In this case, alveolar pulmonary edema is diagnosed.
Lung edema can still be classified by the time of development:
- Acute occurs in 2-4 hours.
- It takes several hours to develop a protracted one. It can last for a day or more.
- Lightning fast is the most dangerous. It starts suddenly, and only a few minutes after the onset of death occurs.
Cardiogenic pulmonary edema
Various diseases can cause the problem of AL. Cardiac pulmonary edema is set when the heart is involved in the pathological process. The diseases that cause it lead to disturbances in the systolic and diastolic functions of the left ventricle. Suffer from the problem mostly people with ischemic heart disease. In addition, pulmonary edema with myocardial infarction, hypertension, heart disease happens. To make sure that the OL is really cardiogenic, you need to check the pulmonary capillary pressure. It should be above 30 mm Hg. Art.
Noncardiogenic pulmonary edema
This kind of OL can be caused by various ailments, leading to one problem - a violation of the permeability of the alveolar membrane. Diseases that cause non-cardiogenic edema:
- pneumonia (both bacterial and viral);
- DIC syndrome;
- acute form of hemorrhagic pancreatitis;
- trauma of the lung.
The big problem is that cardiac and non-cardiac pulmonary edema is difficult to distinguish between each other. In order to correctly differentiate the problem, the specialist should take into account the patient's medical history, assess myocardial ischemia, and measure central hemodynamics. In the diagnostics, a specific test is also used-the measurement of the jam pressure. If the figures are above 18 mm Hg. Art. Is a cardiogenic edema. With the problem of non-cardiac origin, the pressure remains normal.
Toxic pulmonary edema
The state comes because of:
- increase capillary permeability;
- violation of their integrity;
- violations of the main processes occurring in the neurovegetative arc;
- oxygen starvation.
Toxic edema has some peculiarities. He has a distinct reflex period. In addition, the general symptoms of OL are combined with the symptoms of a chemical burn of lung and respiratory tract tissues. Medicine distinguishes four main periods of development of the problem:
- For the first, the manifestation of reflex disorders is characteristic: coughing, severe dyspnea, unceasing lachrymation. In the most difficult cases, a reflex stop of the heart and respiration may occur.
- During the latent period, the phenomena of irritation subsided. It lasts from a couple of hours to several days (but as a rule, no longer than 4 to 6 hours). Although the general well-being of the patient is also stable, diagnostic measures can determine the symptoms of an approaching edema: breathing becomes frequent, the pulse slows down.
- The third stage shows swelling. Lasts about a day. During this period, the temperature rises, neutrophilic leukocytosis develops.
- In conclusion, there are signs of complications, which can become such ailments, as pneumonia or pneumosclerosis.
What causes pulmonary edema?
The reasons why the lungs swell, a lot. Among the main of them are:
- sepsis (in most cases developing against the background of the penetration of toxins into the blood);
- drug overdose;
- pneumonia ;
- an overdose of certain drugs (the most dangerous are anti-inflammatory drugs and cytotoxic drugs);
- radiation damage to the lungs;
- poisoning with poison;
- stasis in the first round of circulation (observed with bronchial asthma, emphysema and other lung diseases);
- a chronic or sudden decrease in the level of protein in the blood (as in cirrhosis, nephrotic syndrome and other kidney pathologies);
- enteropathy;
- acute form of hemorrhagic pancreatitis;
- poisoning with gas ;
- aspiration of the stomach;
- pneumothorax ;
- stay at high altitude;
- excessive uncontrolled introduction of fluid intravenously.
Pulmonary edema with heart failure
This pathology is the final stage of increasing hypertension in the pulmonary circulation. Pulmonary edema in heart disease develops in acute forms of heart failure and disruption of the system as a whole. Cardiogenic edema is characterized by a cough with a discharge of sputum pinkish color. In particularly difficult cases, the patient experiences an acute shortage of oxygen and loses consciousness. Breathing of patients becomes superficial and absolutely ineffective, therefore, ventilation of the lungs is required.
Pulmonary edema at height
Conquest of peaks is a dangerous sport and not only because of the danger of convergence of avalanches. Swelling of the lungs in the mountains is common. And it can even arise in experienced climbers and climbers. The higher you climb the mountains, the less oxygen your body receives. At altitude, the pressure goes down, and the blood that passes through the lungs does not get the right amount of useful gas. As a result, the liquid accumulates in the lungs. And if you do not help with swelling of the lungs, a person may die.
Pulmonary edema in bedridden patients
The human body is not adapted to being in a horizontal position for a long time. Therefore, some recumbent patients begin complications in the form of OL. Symptoms of the problem are the same as in cases caused by serious diseases, but it is a little easier to treat such pulmonary edema, because it is known in advance why it appeared.
And in bedridden patients, pulmonary edema causes the following reasons: in the supine position much less air is inhaled. Because of this, the blood flow in the lungs slows down, and stagnant phenomena develop. Sputum, which contains inflammatory components, accumulates, and expectorate it horizontally is difficult. As a consequence, stagnant processes progress, puffiness develops.
Pulmonary edema - symptoms, signs
Manifestations of acute and protracted OL are different. The latter develops slowly. The first "swallow", warning about the problem, becomes shortness of breath. At first it arises only during physical exertion, but in time, breathing will be difficult even in a state of absolute rest. In many patients, in parallel with shortness of breath, pulmonary edema symptoms are manifested by, for example, rapid breathing, dizziness, drowsiness, general weakness. To indicate the danger may be the procedure for listening to the lungs - strange, gurgling and wheezing sounds are heard in the stethoscope.
Acute pulmonary edema is not difficult to notice. It is usually manifested at night, during sleep. A man wakes up from an attack of severe suffocation. It covers panic, because of which the attack only intensifies. After a while, cough, pallor, pronounced cyanosis, cold sticky sweat, trembling, squeezing pain in the chest area are added to the already existing symptoms. In the process of increasing edema, confusion may occur, blood pressure may fall, or weaken - or not be probed at all - by the pulse.
Pulmonary edema - treatment
Therapy of AL should be aimed at a reduction in order to subsequently completely eliminate all the main causes that caused its occurrence.
Here's how to treat pulmonary edema:
- First of all, all possible measures should be taken to reduce the flow of blood to the lungs. To do this will help the vasodilators, diuretics, the procedure of bloodletting or applying a tourniquet.
- If this is possible, it is necessary to provide conditions for the outflow of blood-mass - by means of accelerating cardiac contractions and reducing peripheral vascular resistance.
- Oxygen therapy helps to eliminate signs of pulmonary edema.
- It is very important to provide the patient with peace and to protect him from stressful situations.
- In the most severe cases, a mixture of 5 ml of 96% alcohol and 15 ml of a 5% glucose solution into the trachea or intravenously is allowed.
Pulmonary edema - emergency aid, algorithm
As soon as the first manifestations of AL are noticed, a person must be helped before the moment of hospitalization. Otherwise, the attack can result in death.
Emergency care for pulmonary edema is carried out according to the following algorithm:
- The victim should be placed in a semi-sitting position.
- Clean the upper respiratory tract from the foam with oxygen inhalation.
- Sharp pain to stop with antipsychotics.
- Restore the heart rate.
- Normalize the electrolyte and acid-base balance.
- With the help of analgesics, restore hydrostatic pressure in a small circle.
- Lower the tone of the vessels and the volume of the intrathoracic plasma.
- First aid for pulmonary edema involves the introduction of cardiac glycosides.
Pulmonary edema - therapy
Serious treatment continues in the hospital. To combat such a problem as pulmonary edema medication will require the following:
- Morphine;
- Fentanyl;
- Furosemide ;
- Korglikon;
- Strofantin;
- Eufillin ;
- Aminophylline;
- antibiotics (in the case of bacterial complications).
Pulmonary edema - consequences
OL can have different consequences. If emergency care has been provided on time and correctly and the subsequent therapy is performed by qualified specialists, even acute pulmonary edema will be safely forgotten. Prolonged hypoxia can result in irreversible processes in the central nervous system and the brain. But in the most terrible cases, the sudden onset of acute edema leads to a fatal outcome.
Pulmonary edema - prognosis
It is important to understand that AL is a problem in which the forecast is often unfavorable. According to statistics, about 50% of patients survive. But if it was possible to diagnose the beginning pulmonary edema, the chances of recovery increase. Puffiness, developing against a background of myocardial infarction, leads to death in 90% of cases. Recovered after an attack of patients a few months must be observed with doctors.