ACUTE PULMONARY EDEMA IN THE EMERGENCY CENTER

Abstract

Acute pulmonary edema is an urgent, acutely life-threatening clinical condition characterized by a sudden accumulation of fluid in the interstitial and alveolar spaces of the lung parenchyma, resulting in severe disruption of alveolar-capillary gas exchange and the development of acute respiratory failure. Under physiological conditions, there is a balance between hydrostatic and oncotic pressure in the pulmonary capillaries, which allows minimal fluid transfer into the interstitial space. In acute pulmonary edema, this balance is disrupted, resulting in excessive fluid filtration into the pulmonary interstitium and alveoli. The accumulated fluid reduces lung compliance, impairs oxygen diffusion, and leads to severe hypoxia. Depending on the etiopathogenetic mechanism, acute pulmonary edema is divided into cardiogenic and noncardiogenic. Cardiogenic pulmonary edema is the most common and occurs as a result of increased hydrostatic pressure in the pulmonary circulation, most often due to left ventricular failure. Noncardiogenic pulmonary edema develops as a result of increased permeability of the alveolar-capillary membrane without a significant increase in capillary pressure. The most common causes of cardiogenic pulmonary edema are acute myocardial infarction, decompensated heart failure, arterial hypertension, mitral and aortic valve diseases, cardiomyopathies, tachyarrhythmias, bradyarrhythmias, myocarditis and hypertensive crisis. Causes of noncardiogenic pulmonary edema are sepsis, acute respiratory distress syndrome (ARDS), aspiration of gastric contents, inhalation of toxic gases, polytrauma, pancreatitis, transfusion reactions, severe infections, intoxications with drugs and narcotic substances and high-altitude pulmonary edema.
The clinical picture of acute pulmonary edema usually begins abruptly and progresses rapidly. Patients are usually anxious, fearful and have a pronounced feeling of shortness of breath. Orthopneic posture is characteristic, in which the patient sits with support on the upper extremities in order to facilitate breathing. The most common respiratory symptoms in acute pulmonary edema are pronounced dyspnea, orthopnea, tachypnea, feeling of suffocation, paroxysmal nocturnal dyspnea, cough with foamy and sometimes pink sputum, cyanosis and moist crepitations over the lungs, while cardiovascular manifestations include tachycardia, arterial hypertension or hypotension, palpitations, arrhythmias, cold and sweaty skin, peripheral vasoconstriction and reduced cardiac output.
The diagnosis is made through clinical assessment, laboratory tests, radiological examinations and continuous monitoring.
Treatment of acute pulmonary edema includes immediate stabilization of the patient with oxygen therapy, drug treatment, respiratory support, and treatment of the underlying cause, with the aim of improving oxygenation and reducing pulmonary congestion