Pulmonary Oedema

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Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Kim Jackson, Aminat Abolade and Kapil Narale  

Introduction

Pulmonary oedema is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extravascular compartments of the lung parenchyma. This process leads to diminished gas exchange at the alveolar level, progressing to potentially causing respiratory failure.

• Its etiology is either due to a cardiogenic process with the inability to remove sufficient blood away from the pulmonary circulation or non-cardiogenic precipitated by injury to the lung parenchyma.
• It is an important pathologic feature in many disease processes
• Determining the underlying disease process is crucial to guide its management.
• Clinical features include progressive worsening dyspnea, rales on lung auscultation, and worsening hypoxia

Clinical Presentation

The clinical presentation of pulmonary oedema includes:

• Progressively worsening dyspnea, tachypnea, and rales (or crackles) on examination with associated hypoxia.
• Acute breathlessness
• Orthopnoea
• Paroxysmal nocturnal dyspnoea (PND)
• Cough, with pink foaming at the mouth (due to hypoxemia from alveolar flooding).
• Distress

Auscultation - mainstay of bedside assessment in all patients with respiratory symptoms. Specifically, hearing of either fine or coarse crackles is very crucial to management.

• Fine crackles are heard in cardiogenic pulmonary edema. They exclusively heard in the inspiratory phase when the small airways, which were shut during expiration, open abruptly

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