PULMONARY EDEMA

How should a patient be evaluated

to establish the cause
of the
acute pulmonary edema
and
to determine appropriate
therapy?
 Pulmonary edema

Cardiogenic Noncardiogenic
pulmonary pulmonary
edema edema

(also termed hydrostatic (also known as increased-

or hemodynamic permeability
edema) pulmonary edema, acute lung
injury, or acute respiratory
distress syndrome).
 History and Physical
Examination

Causes of cardiogenic pulmonary:

- ischemia with or without myocardial infarction

- exacerbation of chronic systolic or diastolic

heart failure

- mitral or aortic valve

- volume overload should also be considered.

 History and Physical
Examination

Noncardiogenic pulmonary edema:

- pneumonia

- sepsis

- aspiration of gastric contents

- major trauma associated with the administration of multiple

blood-product transfusions.
 History and Physical
Examination

Cardiogenic pulmonary edema

- S3 gallop

- Murmur

- Elevated neck veins, an enlarged and tender liver, and

peripheral edema
 History and Physical
Examination

Noncardiogenic pulmonary edema

- The abdominal, pelvic, and rectal examinations are

important
- Warm extremities

- Lung examination is not helpful

 Laboratory Testing

- Electrocardiographic findings

- Elevated troponin level

- Electrolytes, the serum osmolarity, and a toxicology screen

- BNP

below 100 pg per milliliter

(negative predictive value, >90 percent)

greater than 500 pg per milliliter

(positive predictive value, >90 percent).
Chest Radiography
Chest Radiography
 Echocardiography

- Bedside transthoracic echocardiography can evaluate

myocardial and valvular function and can help identify
the cause of pulmonary edema

- Echocardiography is effective in identifying left

ventricular systolic dysfunction and valvular dysfunction

- Echocardiography is less sensitive in identifying diastolic

dysfunction
 Pulmonary-Artery
Catheterization

- 18 mm Hg indicates cardiogenic pulmonary edema

or pulmonary edema due to volume overload.

- the rate of adverse advents was 4.5 to 9.5 percent.

Stepwise approach
 Conclusion

- Careful history and physical examination

- Electrocardiogram

- BNP

- Chest radiograph

- Transthoracic echocardiogram

- Pulmonary-artery catheter