How does pulmonary edema occur in bedridden patients? Additional diagnostic methods

- it's hard pathological condition, associated with the 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 disruption of gas exchange, and hypoxia develops. The gas composition of the blood changes significantly, the concentration increases carbon dioxide. Along with hypoxia, severe depression of 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 tubes 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 absorbed back into the lymphatic vessels that drain into the vena cava. Through this mechanism, the intercellular fluid delivers oxygen and necessary nutrients to cells, removes metabolic products.

Disturbance in quantity and outflow intercellular fluid leads to pulmonary edema:

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

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

Condition assessment

Depending on the rate of transition from the interstitial stage of edema to the alveolar stage, the patient’s condition is assessed. When chronic diseases swelling develops more gradually, more often at night. This swelling can be easily controlled with medications. Edema associated with defects mitral valve, damage to the pulmonary parenchyma increases rapidly. The condition is rapidly deteriorating. Acute swelling leaves very little time to respond.

Disease prognosis

The prognosis for pulmonary edema is unfavorable. 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 treat. After long-term treatment after cardiogenic edema, the 1-year survival rate is 50%. In the lightning-fast form, it is often impossible to save a person.

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

Diagnostics

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

The main symptoms of pulmonary edema include:

frequent coughing;

increasing hoarseness;

cyanosis (the face and mucous membranes become bluish);

increasing suffocation;

tightness in the chest, pressing pain;

Pulmonary edema itself is a disease that does not occur on its own. Many pathologies can lead to edema, sometimes completely unrelated to diseases of the bronchopulmonary and other systems.

Causes of pulmonary edema include:

Overdose of certain (NSAIDs, cytostatics) drugs;

Radiation damage to the lungs;

Overdose narcotic substances;

Infusions in large volumes without forced diuresis;

Poisoning by toxic gases;

Gastric aspiration;

Shock due to serious injuries;

Enteropathies;

Being at high altitude;

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

Cardiogenic edema (cardiac edema)

Cardiogenic edema is always caused by acute left ventricular failure and obligatory stagnation of blood in the lungs. Myocardial infarction, heart defects, arterial hypertension, left ventricular failure are the main causes of cardiogenic edema. To relate pulmonary edema to chronic or acute, pulmonary capillary pressure is measured. In the case of cardiogenic type of edema, the pressure rises above 30 mmHg. Art. Cardiogenic edema provokes transudation of fluid into the interstitial space, then into the alveoli. Attacks of interstitial edema are observed at night (paroxysmal dyspnea). The patient does not have enough air. Auscultation detects harsh breathing. Breathing is increased during exhalation. Choking - main feature alveolar edema.

Cardiogenic edema is characterized by following symptoms:

• increasing cough;

  inspiratory dyspnea. It is typical for the patient sitting position, in the lying position, shortness of breath increases;

  tissue hyperhydration (swelling);

  dry whistling, turning into wet gurgling wheezing;

  separation of pink frothy sputum;

  acrocyanosis;

  unstable arterial pressure. It is difficult to reduce it to normal. A decrease below normal can lead to bradycardia and death;

  strong pain syndrome behind the sternum or in the chest area;

  fear of death;

  The electrocardiogram shows hypertrophy of the left atrium and ventricle, sometimes blockade of the left bundle branch.

Hemodynamic conditions of cardiogenic edema

violation of left ventricular systole;

diastolic dysfunction;

systolic dysfunction.

The leading cause of cardiogenic edema is left ventricular dysfunction.

Cardiogenic edema must be differentiated from non-cardiogenic edema. With non-cardiogenic edema, changes in the cardiogram are less pronounced. Cardiogenic edema occurs more quickly. There is less time for emergency care than for other types of edema. Death is most often caused by cardiogenic edema.

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

Medicines, capable of causing pulmonary edema:

narcotic analgesics;

many cytostatics;

diuretics;

X-ray contrast agents;

non-steroidal anti-inflammatory drugs.

Risk factors for the occurrence of toxic edema are elderly age, long-term smoking.

It has 2 forms, developed and abortive. There is a so-called “silent” edema. It can be detected when x-ray examination lungs. There is practically no definite clinical picture for such edema.

Characterized by periodicity. Has 4 periods:

Reflex disorders. Characterized by symptoms of irritation of the mucous membranes: lacrimation, shortness of breath. The period is dangerous due to respiratory and cardiac arrest;

Hidden period of subsidence of irritation. 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, reaching 24 hours. Most often, symptoms increase within 4-6 hours. During this period, the temperature rises, the blood count shows neutrophilic leukocytosis, and there is a danger of collapse. The developed form of toxic edema has a fourth period of complete edema. The completed period has “blue hypoxemia”. Cyanosis of the skin and mucous membranes. The completed period increases the breathing rate to 50-60 times per minute. Bubbling breathing can be heard from a distance, sputum mixed with blood. Blood clotting increases. Gas acidosis develops. “Gray” hypoxemia is characterized by more severe course. Vascular complications are added. The skin takes on a pale grayish tint. The limbs are cold. Thready pulse and drop to critical values blood pressure. This condition is promoted 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. This is due to left ventricular failure. Pneumonia, pneumosclerosis, emphysema – frequent complications drug-induced toxic edema. At the end of the 3rd week, “secondary” edema may occur due to acute heart failure. Rarely does an exacerbation of latent tuberculosis and other chronic diseases occur. Depression, drowsiness, asthenia.

With fast and effective therapy a period of reverse development of edema begins. It does not belong to the main periods of toxic edema. Here everything depends only on the quality of the assistance provided. Cough and shortness of breath decrease, cyanosis decreases, wheezing in the lungs disappears. The X-ray shows the disappearance of large, then small lesions. The peripheral blood picture is normalizing. The recovery period from toxic edema can be several weeks.

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

Clinical manifestations diseases:

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.

Toxic edema differs from cardiogenic edema by its protracted course and the content of a small amount of protein in the fluid. The size of the heart does not change (it rarely changes). Venous pressure is often within normal limits.

Diagnosis of toxic edema is not difficult. An exception is bronchorrhea due to FOS poisoning.

Occurs due to increased permeability vessels and high filtration of fluid through the wall of the pulmonary capillaries. With a large amount of fluid, the functioning of blood vessels worsens. Liquid begins to fill the alveoli and gas exchange is disrupted.

Causes of non-cardiogenic edema:

stenosis renal artery;

pheochromocytoma;

massive renal failure, hyperalbuminemia;

exudative enteropathy;

pneumothorax can cause unilateral non-cardiogenic pulmonary edema;

severe attack of bronchial asthma;

inflammatory diseases 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 taking medications for a long time acetylsalicylic acid;

  drug addict.

To clearly differentiate edema, the following measures should be taken:

study the patient's history;

apply methods of direct measurement of central hemodynamics;

radiography;

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

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

When the swelling is stopped, it is too early to end the treatment. After an extremely severe condition of pulmonary edema, serious complications often arise:

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

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Death from pulmonary edema occurs in approximately half of cases of its occurrence. Almost always death associated with untimely provision medical care.

The main causes of swelling are:

• heart failure;
• myocardial infarction (and many other heart pathologies);
• renal or liver failure;
• bronchial asthma;
• toxic substances (drugs, medications);
• pneumonia or pleurisy;
• sepsis;
• anaphylactic shock(death occurs in 90% of cases);
• massive injection of saline solutions.

Most often etiology pathological process Acute left ventricular failure occurs with overload of the right heart.

There are cardiogenic and non-cardiogenic types of pulmonary edema. IN last group There is also a toxic form of damage, which has its own characteristics. Toxic pulmonary edema can occur without a typical clinical picture. Because of this, it timely diagnosis can be difficult. In addition, with this type of swelling there is a high probability of re-development of the pathology. However, death from cardiogenic edema is more common, since two important systems for life are affected simultaneously.

Formation of a vicious circle

If a person’s cause of death is pulmonary edema, this may indicate a lack of emergency medical care or a delayed diagnosis of the problem. However, even resuscitation measures it is not always guaranteed that the patient will survive.

The progression of swelling leads to the death of the patient due to the formation of a vicious circle. Stages of its development:

• Provoking factor. This could be physical activity, hypothermia, emotional stress, and so on.
• Increased load on the left ventricle. Since the heart chamber is weakened by a long-term illness, it cannot cope with the load. Blood begins to stagnate in the lungs.
• Increased resistance in blood vessels. An excess of blood in the capillaries causes fluid to leak through the membrane into the lung tissue and alveoli.
• Hypoxia. Gas exchange in the lungs is disrupted, as the foam that appears there interferes with the transport of gases. The blood becomes less saturated with oxygen.
• Decrease reduction. Due to insufficient oxygenation, the myocardium weakens even more. Peripheral vessels dilate. Return venous blood increases towards the heart. There is more blood in the lungs, and extravasation increases.

Independent exit from the formed vicious circle impossible. Therefore, without proper treatment, a person quickly overtakes death.

The rate at which the vicious circle progresses will determine the time it takes for pulmonary edema to lead to death. With a heart attack, death can occur within minutes after the first symptoms appear. And chronic renal failure exhausts the patient for several days. In this case, there is a gradual increase in the symptoms of the pathology.

How to recognize edema to prevent death?

Lung pathology most often develops during sleep. Its first signs will be:

• attacks of suffocation;
• increasing cough;
• dyspnea;
• chest pain;
• blueness of fingertips and lips;
• increased breathing rate;
• increased and weakened pulse.

During auscultation, the doctor may hear dry wheezing sounds. And blood pressure may vary, as it depends on the type of edema. In most cases it is noted sharp increase according to the type of hypertensive crisis. Sometimes it is unstable, but it is most dangerous if the tonometer shows its decrease.

Subsequently, there is an increase existing symptoms and the emergence of new ones. When interstitial pulmonary edema progresses to alveolar edema, pinkish foam appears at the mouth. Cyanosis spreads to the entire body. Breathing becomes even more frequent and bubbling. Using a phonendoscope, you can listen to different types of moist rales.

The main cause of death in this condition is acute ischemia internal organs. In addition, if the patient's blood pressure drops critically, death occurs due to cardiac arrest. To save the patient before the ambulance arrives, the activity of the heart and breathing should be maintained in every possible way.

How to avoid death?

The first action when edema develops is to call an ambulance. While doctors get to the patient, he should be in a semi-sitting position. If respiratory or cardiac arrest is observed, it is necessary to urgently proceed to resuscitation measures.

Having diagnosed pulmonary edema in a patient, the doctor emergency assistance under no circumstances tries to immediately transport him to the hospital. The chance that the patient will not die on the way is very low. First, the victim is given emergency treatment which includes:

• maintaining vital functions;
• eliminating foam from the respiratory tract;
• decrease in fluid volume in the body;
• pain relief;
• correction of electrolyte and acid balances.

However, you can die from pulmonary edema even if you perform all the necessary manipulations. The body's reaction to medications can be unpredictable. For example, pathology can develop into a lightning-fast form and kill the patient in a few minutes. But performing emergency care is mandatory item therapy that increases the chances of survival.

After completing the full scope of manipulations, the patient is hospitalized, where the main treatment begins. After getting rid of pulmonary edema, the risk of death is still not zero, as they may develop dangerous complications. The most unfavorable of them are hypoxic damage to the brain and other internal organs. They are irreversible and cause death or disability.

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Pulmonary edema, the causes and consequences of which can be quite serious, is dangerous disease threatening the patient's life.

Therefore, if this symptom is detected in a person, immediate consultation with a doctor is required.

Pulmonary edema occurs due to exposure external factor, affecting the accumulation serous fluid in the alveoli, which leads to disruption of the exchange of carbon dioxide and oxygen. The lung may swell due to blood stagnation or damage to the lung structure.

This symptom is very dangerous for human life. If the patient is not provided with qualified medical care in a timely manner, the consequences can be dire. Often, swelling of the lung causes death.

The alveoli, which make up the lungs, are thin sacs lined with small blood vessels. If swelling occurs, they fill with fluid, which leads to a disruption in the functioning of the organ and the exchange of oxygen with carbon dioxide. As a result, oxygen starvation of all organs occurs.

In medicine, there are two types of pulmonary edema: hydrostatic edema and membrane edema.

Hydrostatic and membranous edema

Reasons why it occurs this problem, are quite varied. This can include any illness or condition human body, in which there is an increase in pressure in the lungs.

As a rule, this is a heart defect (acquired or congenital), diseases associated with the heart valve, thrombosis, pulmonary failure and embolism, tumors (especially malignant ones), bronchial asthma and chronic obstructive heart disease.

This type of pulmonary edema can occur due to infectious diseases And inflammatory processes, therefore it is not excluded in pneumonia and sepsis. In addition, membranous edema occurs due to poisoning with harmful vapors, for example, chlorine, carbon monoxide or mercury. Often the cause is the entry of stomach contents into the alveoli.

Swelling can occur due to the penetration of water into the alveoli, as well as as a result of foreign objects into the respiratory tract.

Edema in heart disease

With congenital or acquired diseases of the heart and blood vessels, the possibility of developing swelling in the lungs cannot be ruled out. The reason for this is insufficient blood circulation, which leads to increased blood pressure. If there is blood long time is located in the walls of blood vessels, its plasma begins to penetrate the alveoli and accumulate there.

Pulmonary edema often occurs in people when acute heart attack myocardium, post-infarction cardiosclerosis or atherosclerotic, heart disease (acquired and congenital), left ventricular dysfunction, as well as diastolic and systolic dysfunction.

Intoxication and lung diseases

If the alveoli of the lungs are exposed to harmful substances or aggressive compounds, this can lead to swelling of the organ and death of the patient. This happens when a person inhales toxic gases or poison, as well as when taking certain medications incorrectly.

Other types of intoxication that can lead to pulmonary edema include drug or alcohol poisoning. A similar reaction is possible with allergies to certain substances. Pulmonary edema often causes death.

Infection in the body also leads to toxin poisoning. This can also cause swelling in the lungs. Thus, dangerous symptom may occur with sepsis, influenza, chronic tonsillitis, acute laryngitis and whooping cough.

Diseases that affect the organ itself can cause pulmonary edema. This happens when chronic bronchitis, lung tumors, tuberculosis, bronchial asthma and pneumonia.

Sometimes the problem is caused by problems not only in the lung itself, but also in other organs. For example, fluid accumulation may occur due to improper functioning of the kidneys and liver. If there is a predisposition to this, then swelling can develop even due to physical or emotional stress.

Climate change

When we're talking about about acclimatization, you need to be extremely careful. This is especially true for those who are going to travel with a sharp change in climate or go high into the mountains. Experts note that often those who decide to climb the mountain for the first time greater height, may arise big problems with the body, including swelling of the lungs. As a rule, this is observed when a person crosses 3.5 thousand meters above sea level. When significant physical activity is added to this, the risk of developing the worst scenario increases significantly.

If a person climbs a mountain, this does not mean that the problem will manifest itself immediately. In most cases, about three days pass before swelling develops, only then do the first signs appear. People who have chronic illnesses are at particular risk respiratory system or problems with blood circulation. In this case, the patient has a dry cough for some time, severe weakness and sore throat.

For high altitudes, such a symptom is very dangerous. It is not always possible to quickly go to the clinic for help with pulmonary edema. In this case, swelling can develop very quickly, and the death of the patient becomes inevitable.

The first thing to do in such a situation is to carry out warming procedures. In this case, the person needs to be laid down, but the head should be raised slightly. Painful symptoms must be relieved with appropriate medications. Acidified water is recommended for drinking. If possible, the patient should be provided with additional oxygen.

The help of specialists in this case will be extremely necessary, otherwise the patient’s chances of survival are minimal.

How to recognize pulmonary edema?

This problem manifests itself in several characteristic features, so diagnosing it is not difficult. Depending on the speed of development of symptoms of pulmonary edema and pathogenesis, the disease can be divided into four stages.

Approaching swelling is indicated by shortness of breath, rapid breathing and pulse, severe cough and wheezing in the throat. If the patient puts pressure on the chest, it will cause painful sensations. The later stage is characterized rapid heartbeat, cold sweat and difficulty breathing. A person tries to stay in a sitting position more, because this makes breathing much easier.

If at first a dry cough predominates, then at a more advanced stage it will develop into a wet one. In this case, wheezing is heard and pinkish sputum appears, which over time can come out through the nose.

Acute pulmonary edema is characterized by bubbling, intermittent and loud breathing. As soon as pulmonary edema increases, other symptoms are sure to appear (low blood pressure, weak pulse and loss of consciousness).

All stages of pulmonary edema occur at different rates. Much depends on how quickly fluid accumulates in the alveoli. If we are talking about fulminant edema, then everything happens so quickly that even ambulance sometimes it fails to save the patient. With the gradual development of symptoms, the patient or his relatives have the opportunity and time to seek help qualified help to professionals.

Consequences of edema

If a person experiences symptoms of swelling of the respiratory system, this is quite dangerous and can cause death. For this reason, pulmonary edema requires urgent medical attention for treatment.

It must be remembered that this disease often causes oxygen starvation throughout the body and leads to failure of internal organs. This is especially dangerous for the brain.

The prognosis for timely treatment of pulmonary edema is quite favorable. In most cases, everything ends well. If there is no medical assistance, even with the slow development of swelling, the likelihood of death is extremely high. Most likely, the patient will die from asphyxia.

With timely and correct treatment, pulmonary edema responds well to treatment, many patients recover completely and no problems arise in the future. The only case when doctors cannot guarantee positive result, this is pulmonary edema, which is combined with cardiogenic shock. In such a situation, recovery is rather rare.

Pulmonary edema is quite serious condition, in which the transudate leaves the capillaries and enters the tissues of the lung and alveoli. This process leads to decreased function of the alveoli, as well as disruption of normal gas exchange and oxygen starvation. Against this background, the composition of the blood changes significantly, and 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 is often the cause of death in humans of different ages. The prognosis depends on the speed of providing first aid to the patient.

General description of the pathology

The development of the primary mechanism of edema is very complex. The interstitium consists of lymphatic vessels, connective tissue, blood vessels and intercellular fluid. The entire complex is exposed by a special visceral pleura. The extensive branching of hollow tubes makes up the lungs. The entire respiratory system is immersed in the interstitium. This substance is formed by plasma that comes out of blood vessels. After this, 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 necessary nutritional components to the cells and removes metabolic products from them.

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

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

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

Pulmonary edema in heart disease develops rapidly, the patient’s condition deteriorates very quickly and there is very little time to provide first aid.

In the fulminant 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. Reason acute edema lungs can be:

• Diseases that are accompanied by the release of various toxins into the blood. This is observed with sepsis and pneumonia, as well as with an overdose of certain medications and drugs, such as heroin and cocaine. Radiation damage also leads to edema lung tissue. Toxins greatly disrupt the structure of the membrane, due to this its permeability increases significantly, and liquid from small capillaries leaves the vessels.
• Heart pathologies in the stage of decompensation, which are accompanied by failure of the left ventricle of the heart and significant congestion in the pulmonary circulation. This is typical for heart attack and severe heart defects.
• Lung diseases that lead to stagnation in the right circle of blood circulation. Such pathologies include bronchial asthma and emphysema.
• Thromboembolism of the pulmonary artery. This phenomenon occurs when there is a tendency to develop blood clots. The risk group includes patients with hypertension and varicose veins veins In such patients, a blood clot may form, which then breaks off from the vascular wall and migrates throughout the body with the bloodstream. Once in pulmonary artery a clot clogs it. It leads to strong increase pressure in the vessel and the capillaries extending from it. Fluid pressure increases in these vessels, which ultimately leads to the accumulation of excess liquid in the lungs.
• Pathologies that are accompanied by a decrease in protein levels in the blood. This includes severe liver and kidney diseases. In patients with liver cirrhosis 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.. Moreover, in an elderly person the risk of developing such a pathology is much higher than in young people.

Athletes who train hard have a high risk of developing pulmonary edema. Some athletes after hard training swelling occurs in a mild form; female athletes suffer from this disease more often than men.

Clinical picture

Symptoms of pulmonary edema most often appear suddenly and increase very rapidly. Symptoms completely depend 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:

• Spicy. 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 a heart defect that occurs due to severe stress or active physical activity. The acute form of pulmonary edema often accompanies myocardial infarction.
• Subacute. Lasts from 4 to 12 hours. Occurs due to fluid retention, mainly due to renal or liver failure. Happens when congenital defect heart and anomalies of large vessels. Often occurs when lung tissue is damaged by toxins or infections.
• Lingering. It may last a day or more. Happens when chronic failure kidneys, inflammatory lung diseases and some systemic pathologies of connective tissues.
• Lightning fast. Just a few minutes after the onset of the pathological process, the person dies. This type of pulmonary edema is the most common cause death due to myocardial infarction and anaphylactic shock.

Against the background of chronic diseases, pulmonary edema often begins at night. This is due to prolonged horizontal position person. If the cause of fluid accumulation is a blood clot, the person’s condition may worsen sharply. different time days. Pulmonary edema in older people is especially difficult 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 the patient breathing even at a distance of several meters.
• Attacks of severe suffocation occur suddenly. The patient feels acute shortage air, this is especially noticeable when lying on your back. In this case, the person takes a semi-sitting body position, in which it is easier for him to breathe.
• Lack of oxygen leads to severe pressing pain in the chest.
• The work of the heart is greatly impaired, palpitations are noticeable.
• A cough occurs with strong wheezing, which can be heard even from a distance. When you cough, pink foam comes out profusely.
• When examining the patient, you may notice abnormal pallor and cyanosis of the skin. The person sweats profusely, and the sweat is cold and sticky. All these phenomena are associated with circulatory disorders.

In addition to these signs, confusion is observed. A person first becomes overly excited and is haunted by fears of death. As the disease progresses, excitement turns into inhibition and ultimately the person may fall into a coma.

The mortality rate from pulmonary edema is very high. The prognosis depends on the form of edema and the speed of treatment to the patient necessary assistance. At the first symptoms of the disease, you should urgently call a doctor.

Diagnostics

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

If the patient is in unconscious, then a presumptive diagnosis is made based on an examination of the person. Based on the examination results, the doctor can suggest the causes of this pathological condition.

When examining a patient, the specialist pays attention to the pallor and cyanosis of the skin. Excessively pulsating neck veins and shallow, rapid breathing should alert the doctor.

The patient's pulse is weak and thread-like. The doctor may note that it is viscous cold sweat, which covers the patient's body. When tapping the lung area, there is some dullness of sound over the respiratory organs. This speaks of high density lung tissue. When listening to the lungs with a stethoscope, you can hear hard breathing which is accompanied by wheezing. Pressure with this pathology can increase significantly.

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

• General blood test - with this test you can see if there is infectious process in organism.
• Biochemical blood test - helps 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 provoked by a decrease in protein in the blood. If the results of such an analysis show that the level of urea and creatinine is increased, then we can talk about kidney pathology, which became the cause of swelling of the respiratory organs.
• Analysis to assess blood clotting. Indicates edema that arose due to thromboembolism of the pulmonary artery.

The patient must undergo a blood gas test. If, according to the results of the analysis, there is a noticeable increase in carbon dioxide in the blood, then pulmonary edema can be suspected.

Some are appointed instrumental methods diagnostics, these include:

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

The patient must be sent for an x-ray chest. This study allows you to confirm or refute 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 will be visible on the image.

Sometimes narrow specialists are also involved to clarify the diagnosis and prescribe treatment. This could 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, he is immediately placed in the intensive care unit.

If a person has signs of pulmonary edema, it is necessary to urgently call an ambulance. Even during the transportation process, the patient is given first aid according to the approved protocol. Urgent Care includes the following activities:

• The patient is placed comfortably in a semi-sitting position. In this position, breathing becomes much easier.
• Oxygen therapy is carried out according to indications. If breathing is very difficult, then tracheal intubation is performed and then artificial ventilation is performed.
• IN clinical guidelines In providing first aid, the patient must dissolve nitroglycerin tablets.
• If necessary, the patient is given morphine for pain relief.
• To reduce blood flow to the right side of the heart and prevent an increase in pressure in the pulmonary circulatory system, venous tourniquets are placed on the patient’s legs. When applying bandages, you need to make sure that the pulse in the limbs is palpable.

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

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

• Antifoam agents are often used for pulmonary edema. They consist of pure oxygen and ethyl alcohol vapor.
• If blood pressure is elevated and there are signs of myocardial damage, nitroglycerin is prescribed.
• Diuretics or diuretics, to quickly remove excess fluid from the body.
• Drugs to increase heart contractions.
• If you're worried strong pain, prescribe drugs based on morphine.
• If there are signs of thromboembolism, then anticoagulants are prescribed.
• If the heart is too slow, it is prescribed.
• For symptoms of bronchospasm, hormonal drugs are indicated.
• If the cause of the swelling is some kind of infection, then broad-spectrum drugs are prescribed.

In some cases, a transfusion of blood or fresh frozen plasma is indicated. The duration of treatment for this pathology can vary significantly. This 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! At home, the patient can only receive emergency care.

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, so in this case the mortality rate is higher. The consequences of cardiogenic pulmonary edema in older people are especially sad. The survival rate 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 fluid accumulation in the body. If there are danger signs pulmonary pathology, you should immediately call an ambulance.

May have various reasons and consequences, this is a pathology that can result from diseases of the heart, liver and kidneys. What processes occur in the body during 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 swelling 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 is beginning? Typically these are the following signs:

Factors causing the development of edema

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

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

Development of edema in infants

What causes edema in young children who have not yet had 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 divided into groups depending on the cause of their development. There are 2 types of edema:

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

  Since cardiogenic edema occurs very quickly, it often causes sudden death person.

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

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

Possible risks of developing edema

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

The development of the syndrome can lead to:

Swelling of the lungs can also cause:

• ischemic lesion various organs, as well as body systems;
• development of bronchitis or pneumonia;
• cerebral circulatory disorders;
• segmental atelectasis;
• heart failure;
• pneumofibrosis;
• cardiosclerosis.

How will pulmonary edema progress and will it Negative consequences for human health and life depends on the reasons that cause it. However, it is possible to cope with this pathology, but only with timely help from specialists.