Pulmonary edema, CPE and NCPE

Notes
  • Pulmonary edema is fluid accumulation in the alveoli of the lungs
  • There are two types of pulmonary edema: Cardiogenic pulmonary edema (CPE) and Non-cardiogenic pulmonary edema (NCPE)
  • ##CPE:
  • It an acute a condition that is caused by severe left ventricular failure that results in pulmonary venous hypertension and alveolar flooding or pulmonary edema
  • It is more of a symptom of severe left ventricular failure
  • It has a history of an acute cardiac event while NCPE rarely has any
  • On physical examination, CPE shows a low-flow state, an S3 gallop, jugular venous distention, and crackles on auscultation while NCPE has a warm periphery, a bounding pulse, and no S3 gallop or jugular venous distention.
  • The pulmonary capillary wedge pressure (PCWP) is mostly >18 mm Hg in CPE and < 18 mm Hg in NCPE

##NCPE:

  • It is associated with injury to the alveolar-capillary membrane
  • It occurs in such conditions as fat emboli, pneumonia, aspiration pneumonitis, drowning, toxin inhalation, pulmonary contusion, radiation sepsis, shock, multiple transfusions and acute pancreatitis, lymphatic insufficiency, rapid removal of pneumothorax among others
  • Statistics: For CPE refer to “Congestive Heart Failure” details in this publication
Symptoms

##Symptoms and Signs of CPE

  • Shortness of breath or apnea (which is the most common symptom) and it can be Orthopnea (shortness of breath while lying flat) or Paroxysmal Nocturnal Dyspnea (where the patient wakes up at night with shortness of breath with a need to walk around to relieve the symptom)
  • Cyanosis
  • Sweating
  • Rhonchi and crepitation
  • Frothy blood-tinged sputum
Diagnosis
  • Chest X-ray (diffuse haziness of lung field, Kerley B lines and loss of distinct vascular margin in CPE)
  • Electrocardiography (ECG)
  • Chest radiography
  • Echocardiography
Differential
  • Acute Respiratory Distress Syndrome
  • Asthma
  • COPD/pulmonary fibrosis
  • Deep venous thrombosis
  • Emphysema
  • High-altitude pulmonary edema
  • Myocardial Infarction
  • Myocardial ischemia
  • Neurogenic pulmonary edema
  • Pneumonia
  • Pneumothorax
  • Pulmonary embolism
  • Venous stasis
Prevention
  • Investigation and Management of the underlying causes
Management

## CPE

  • Refer to “Congestive Heart Failure” details in this publication
  • Propping patient in bed
  • Administration of 100% oxygen at a rate of 3.5-5L/min
  • Administration of IV Frusemide 40mg STAT then increase the dosage every 20-30 minutes up to a maximum total dose of 200mg
  • Digitalize the patient unless there is myocardial infarction as highlighted under “Congestive Heart Failure”
  • Administration of IV infusion Aminophylline 250-500mg
  • Sublingual Nitroglycerin
  • Management of the underlying causes such as hypertension

##NCPE

  • Management of the underlying causes such as hypertension
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