Pulmonary Oedema

Introduction

Pulmonary Oedema occurs when there is congestion of the lungs with fluid, usually in a scenario of left-sided cardiac failure. This results in stiffness of the lungs and flooding of the alveoli, with difficulty in breathing.
Pulmonary Oedema may also follow inflammatory processes
It may be acute or chronic

Clinical features

  • Difficulty in breathing, with a sensation of drowning
  • Cough productive of frothy (sometimes pink) sputum
  • Central cyanosis
  • Sweating, agitation etc
  • Other symptoms of left-sided cardiac failure

Examination:

  • Wide-spread crepitations
  • Rhonchi (in severe cases)
  • Other signs of left-sided cardiac failure

Differential diagnoses

  • Pulmonary embolism
  • Pneumonia

Complications

  • Hypoxaemia
  • Coma

Investigations

  • Chest radiograph
  • Electrocardiography
  • Echocardiography
  • Blood gases
  • Urea, Electrolytes and Creatinine
  • D-Dimer

Treatment objectives

  • Relieve oedema
  • Relieve discomfort
  • Treat underlying cause

Non-drug treatment

  • Propped up position
  • Bed rest
    • Sit on bed with legs hanging down

Drug treatment

  • Oxygen 3-5L/min
  • Morphine 10 mg stat
  • Loop diuretics: Furosemide 40-120 mg intravenously stat; maintenance with 40 – 500 mg daily in single or divided doses
  • Venodilator: 0.3-1 mg by mouth or 10-200  microgram/min intravenously
  • Vasodilator: Hydralazine 25-50 mg 12 hourly; ACEI (Captopril: 6.25-25 mg by mouth)
  • Aminophylline 250-500 mg or 5mg/Kg intravenously over 10 minutes

Supportive measures

  • Nursing care (e.g. nurse in cardiac position)

Notable adverse drug reactions

  • Diuretics: hpokalaemia
  • ACEIS: First dose hypotension, dry cough,
  • Nitrates: Hypotension
  • Aminophylline: Arrhythmias hyperkalaemia

Prevention

  • Treat cause(s) of cardiac failure or fluid overload (e.g. renal failure)
  • Judicious administration of blood and intravenous fluids.