Pulmonary edema

Pulmonary edema ( colloquially lung water ) is a non-specific term leakage of blood fluid from the capillaries into the interstitium and alveoli of the lungs. Thus, the affected person can not absorb enough oxygen into the bloodstream. When symptoms are shortness of breath, rales and / or a frothy expectoration. Pulmonary edema, a distinction depending on the cause in Permeabilitätsödeme (ARDS, toxic pulmonary edema ) and hydrostatic pulmonary edema ( cardiac edema or Höhenödem ). Formally, the permeability ( the water flow through the vessel wall through ) is described by the Starling equation.

Molding

Pulmonary congestion

A lower expression of the pulmonary edema, the subacute or chronic form, which is referred to as pulmonary congestion.

Cardiogenic pulmonary edema

The cardiac pulmonary edema, the most common form of pulmonary edema, is no lung disease. It is produced during acute left ventricular failure. Cause of the failure of the left heart is usually an acute decompensation of chronic heart failure in which the heart's left side due to a weakness of the return flow of blood from the lungs can no longer cope. There is a backlog of blood in the pulmonary vessels and - because of the resulting increased pressure - to a leakage of fluid into the lung tissue. Thus, the gas exchange is severely restricted. Often the patient breathe panting ( cardiac asthma ), are restless and have Erstickungsängste. Usually there is a marked cyanosis.

Acute pulmonary edema in left heart failure is a medical emergency that if left untreated apnea and this can lead to death in minutes of the patient.

Is treated emergently with head of bed elevation, ventilation with oxygen supplementation, catecholamines, nitroglycerin and diuretics administration / brisk diuresis and early alerting of emergency services and first aid.

Is not there a possibility of adequate drug therapy, the bloodless bloodletting is in first aid for bridging to a hospital therapy is an effective method to relieve the pulmonary circulation by blood volumes "parked" in the extremities temporarily be retained. This has to pump a smaller volume, the left half of the heart. The backlog in the pulmonary vessels is reduced usually - gas exchange in the lung is partially possible.

Not Cardiac pulmonary edema

Acute lung injury ( engl. acute respiratory distress syndrome, ARDS ) occurs as a result of increased vascular permeability, either due to inflammatory processes or due to toxins ( Acute pulmonary edema). Clinically, ARDS is defined by typical opacities on the radiograph, hypoxemia, exclusion of a cardiac edema (see above) and its acute onset.

Common causes of ARDS are sepsis, multiple trauma, aspiration of gastric contents or serious burns. Also described only a few years SARS virus leads to the clinical picture of ARDS. ARDS often occurs in connection with the failure of other organs on ( multiple organ failure ). The mortality rate in the presence of ARDS is still even in premature initiation of therapy at about 50 percent.

A high altitude pulmonary edema ( engl. high altitude pulmonary edema, HAPE ) may occur at the level of disease and is caused by an increased pulmonary arterial pressure as a result of hypoxia ( Euler - Liljestrand mechanism). It usually develops one to three days after a rapid rise to over 2,700 m. Symptoms include shortness of breath, cough with frothy or bloody sputum, cyanosis, weakness, in later stages coma. Therapy is the immediate descent and return transport.

A rare form of lung edema is the post obstruction pulmonary edema (English negative pressure pulmonary edema, NPPE ). This is caused by a negative pressure in the lungs, such as may occur from the combination of the closed upper airway while deep inspiration. This can be caused, for example, laryngospasm, biting of the endotracheal tube or the laryngeal mask in Narkoseausleitung or other airway obstruction. In addition, an incorrect approach comes during suctioning in question. The NPPE is characterized by rapid onset after appropriate incident.

Symptoms

The symptoms are represented in both the cardiac and the toxic or allergic pulmonary edema.

Patients with pulmonary edema suffer from anxiety, suffocation, severe shortness of breath ( even at rest ) to the cyanosis. They usually sit by himself with an upright upper body so as to permit the use of accessory respiratory muscles. When inhaling and exhaling and bubbling rales are heard, possibly accompanied by spastic respiratory sounds. Other signs are moist and cool skin ( cold sweat ) and pallor, tachycardic pulse partly arrythmisch and with different blood pressure (eg high in combination with hypertensive crisis or low in heart failure with cardiogenic shock).