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Management of Lung Oedem
Management of Lung Oedem
PULMONARY OEDEM
Sri Sulistyowati
Wisnu Prabowo
Wisnu Prabowo
FETOMATERNAL DIVISION
OBSTETRICS AND GYNECOLOGY DEPARTMENT
SEBELAS MARET UNIVERSITY/DR MOEWARDI HOSPITAL
SURAKARTA
Acute Pulmonary Oedema
Characterised
dyspnea & hypoxia secondary to
fluid accumulation in the lungs which Mortality rate + 40%.
impairs gas exchange and lung
compliance
Medical Emergecies
which requires immediate
management
Causes
(starling
equation)
Electrocardiography, echocardiography
Spiral CT Imaging
Pulmonary arteriography
Pulmonary embolism
To Exclude cardiopulmonary pneumonia
compromise
cardiomyopathy
Arterial Blood Gas Values in Nonpregnant
and Pregnant Women
Nitrate
Smooth Muscle Increased
Improve
relaxation coronary blood
oxygenation
flow
Reduce
Coronary
Venodilation workload of
arteries
heart
Preload Reduced
Given
reduction at low afterload &
sublingually
dose Blood pressure
Speed onset on
Arteriolar
Higher dose IV line & ability
dilatation
titrate dose
Nitrate
Associated
hypotension
Associated
tachyphylaxis within BP maintain >
16-24hrs continous 90mmHg
administration
Contraindicated
Adverse effect:
phosphodiesteras
paradoxical
e invibitor
bradicardia
(sildenafil)
Adverse Adverse
effect : effect :
tachycardia headache
Coons JC, McGraw M, Murali S. 2011
Diuretics
• Furosemide 40-80mg
• A small RCT did not find difference outcome between bolus and
continous infusion
• Dobutamine: peripheral
• Impaired left ventricular
vasodilatory effects
function and hypotension IV
worsening hypotension
infusion of dobutamine.
vasopressor.
• Dobutamine: cause
arrhythmias and
contraindicated if patient has
ventricular arrhythmias or rapid
atrial fibrillation.
• Another inotrope that may increase cardiac output and
improve peripheral perfusion is milrinone
Enlarging uterus
Increased O2
consumption
and CO2 production
.w medtau.org
PRE-ECLAMPSIA
VASCULAR BLOOD
LEAKAGE PRESSURE
DIRECT IMPACT ON
PULMONAL CAPILLARY
VESSELS
PLEURAL
LUNG EDEMA
EFFUSION
LOW VENTILATOR
SATURATION
MAGNESIUM INTUBATION INDIRECT
SIDE EFFECT IMPACT
CONVULSION
UNCONCIOUSC VAP
PATHOGENESIS
OF PULMONARY EDEMA IN
PREECLAMPSIA
PATHOGENESIS
OF PULMONARY EDEMA
IN PREECLAMPSIA
Oxidative
Stres
VENTRICULAR DYSFUNCTION –
LVH (HIGH PERIPHERAL
RESISTANCE + INCREASING
PLASMA LEVELS
Pathogenesis Pulmonary Oedema in
Preeclampsia
• Increase plasma blood
volume, cardiac output,
HR, capillary
permeability, decrease
colloid osmotic pressure
•Pulmonary
Oedema
Pathogenesis Pulmonary Oedema in
Preeclampsia
• These changes
• Fluid shift secondary to
explain at least 70-
increased capillary permeability
80% PO in
(esp in Preeclampsia) or
Preeclampsia develop
excessive crystalloid infusion
after delivery
Management of acute pulmonary
edema-- LMNOP
• Lasix (furosemide)
• Morphine sulfate 2 to5 mg in an attempt to reduce the
adrenergic vasoconstrictor stimuli to the pulmonary arteriolar
and venous beds
• Na+ and water restriction
• Oxygen supplementation and capillary leak syndrome has
been breathed by mechanical ventilation and PEEP 5-15
cmH2O
• Positioning (elevation) by reducing pulmonary capillary
wedge pressure
THE ART OF FUROSEMIDE USAGE IN PE
COMPLICATED BY LUNG EDEMA
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the
management of adults with hospital-acquired, ventilator-associated, and healthcare-
associated pneumonia.
Treatment