lung edema

肺水腫

関

pulmonary edema

WordNet

1. either of two saclike respiratory organs in the chest of vertebrates; serves to remove carbon dioxide and provide oxygen to the blood
2. swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities (同)oedema, hydrops, dropsy

PrepTutorEJDIC

1. 《しばしば複数形で》『肺』,肺臓
2. 浮腫(ふしゅ),水腫

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/14 08:55:12」(JST)

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Pulmonary edema
Classification and external resources
Pulmonary edema with small pleural effusions on both sides.
ICD-10	J81
ICD-9	514 518.4
DiseasesDB	11017
MedlinePlus	000140
eMedicine	article/157452 article/300813, article/360932
MeSH	D011654

Pulmonary edema (American English), or oedema (British English; both words from the Greek οἴδημα), is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the left ventricle of the heart to adequately remove blood from the pulmonary circulation ("cardiogenic pulmonary edema"), or an injury to the lung parenchyma or vasculature of the lung ("noncardiogenic pulmonary edema"). Treatment is focused on three aspects: firstly improving respiratory function, secondly, treating the underlying cause, and thirdly avoiding further damage to the lung. Pulmonary edema, especially in the acute setting, can lead to respiratory distress, cardiac arrest due to hypoxia, and death.

Symptoms and signs

The overwhelming symptom of pulmonary edema is difficulty breathing, but may also include coughing up blood (classically seen as pink, frothy sputum), excessive sweating, anxiety, and pale skin. Shortness of breath can manifest as orthopnea (inability to lie down flat due to breathlessness) and/or paroxysmal nocturnal dyspnea (episodes of severe sudden breathlessness at night). These are common presenting symptoms of chronic pulmonary edema due to left ventricular development of pulmonary edema may be associated with symptoms and signs of "fluid overload", this is a non specific term to describe the manifestations of left ventricular failure on the rest of the body and includes peripheral edema (swelling of the legs, in general, of the "pitting" variety, wherein the skin is slow to return to normal when pressed upon), raised jugular venous pressure and hepatomegaly, where the liver is enlarged and may be tender or even pulsatile. Other signs include end-inspiratory crackles (sounds heard at the end of a deep breath) on auscultation and the presence of a third heart sound.

Causes

Pulmonary edema on CT-scan (coronal MPR)

Pulmonary edema is an accumulation of fluid within the parenchyma and air spaces of the lungs. Classically it is cardiogenic (left ventricular) but fluid may also accumulate due to damage to the lung. This damage may be direct injury or injury mediated by high pressures within the pulmonary circulation. When directly or indirectly caused by increased left ventricular pressure pulmonary edema may form when mean pulmonary pressure rises from the normal of 15 mmHg to above 25 mmHg. Broadly, the causes of pulmonary edema can be divided into cardiogenic and non-cardiogenic. By convention cardiogenic refers to left ventricular causes.

Cardiogenic

• Left ventricular failure may be due to a heart attack leading to arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat) and fluid overload, e.g., from kidney failure or intravenous therapy which may cause dilatation and failure of the left ventricle or may cause pulmonary edema in the absence of heart failure.

Non-cardiogenic

• Hypertensive crisis. The cause of pulmonary edema in the presence of a hypertensive crisis is probably due to a combination of increased pressures in the right ventricle and pulmonary circulation and also increased systemic vascular resistance and left ventricle contractility increasing the hydrostatic pressure within the pulmonary capillaries leading to extravasation of fluid and edema.
• Upper airway obstruction (negative pressure pulmonary edema )
• Neurogenic causes (seizures, head trauma, strangulation, electrocution).

Other/unknown

Injury to the lung may also cause pulmonary oedema through injury to the vasculature and parenchyma of the lung. The acute lung injury-acute respiratory distress syndrome (ALI-ARDS) covers many of these causes, but they may include:

• Inhalation of hot or toxic gases
• Pulmonary contusion, i.e., high-energy trauma (e.g. vehicle accidents)
• Aspiration, e.g., gastric fluid
• Reexpansion, i.e. post large volume thoracocentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema.
• Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
• Immersion pulmonary edema
• Multiple blood transfusions
• Severe infection or inflammation which may be local or systemic. This is the classical form of ALI-ARDS.

There are also a range of causes of pulmonary edema which are less well characterised and arguably represent specific instances of the broader classifications above.

• Arteriovenous malformation
• Hantavirus pulmonary syndrome
• High altitude pulmonary edema (HAPE), probably a manifestation of neurogenic pulmonary edema
• Envenomation, such as with the venom of Atrax robustus
• Flash pulmonary edema
• Swimming induced pulmonary edema

Diagnosis

X-Ray showing pulmonary oedema

There is no one single test for confirming that breathlessness is caused by pulmonary edema; indeed, in many cases, the cause of shortness of breath is probably multifactorial.

Low oxygen saturation and disturbed arterial blood gas readings support the proposed diagnosis by suggesting a pulmonary shunt. Chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing peri-hilum pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), and possibly pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated with noncardiogenic edema

Especially in the case of cardiogenic pulmonary edema, urgent echocardiography may strengthen the diagnosis by demonstrating impaired left ventricular function, high central venous pressures and high pulmonary artery pressures.

Blood tests are performed for electrolytes (sodium, potassium) and markers of renal function (creatinine, urea). Liver enzymes, inflammatory markers (usually C-reactive protein) and a complete blood count as well as coagulation studies (PT, aPTT) are also typically requested. B-type natriuretic peptide (BNP) is available in many hospitals, sometimes even as a point-of-care test. Low levels of BNP (<100 pg/ml) suggest a cardiac cause is unlikely.

Prevention

In those with underlying heart disease, effective control of congestive symptoms prevents pulmonary edema.

Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension, the mechanism of action is via phosphodiesterase inhibition which raises cGMP, resulting in pulmonary arterial vasodilation and inhibition of smooth muscle cell proliferation. While this effect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent has been delayed for some reason.

Management

The initial management of pulmonary edema, irrespective of the type or cause, is supporting vital functions. Therefore, if the level of consciousness is decreased it may be required to proceed to tracheal intubation and mechanical ventilation to prevent airway compromise. Hypoxia (abnormally low oxygen levels) may require supplementary oxygen, but if this is insufficient then again mechanical ventilation may be required to prevent complications. Treatment of the underlying cause is the next priority; pulmonary edema secondary to infection, for instance, would require the administration of appropriate antibiotics.

Cardiogenic pulmonary edema

Acute cardiogenic pulmonary edema often responds rapidly to medical treatment. Positioning upright may relieve symptoms. Loop diuretics such as furosemide or bumetanide are administered, often together with morphine or diamorphine to reduce respiratory distress. Both diuretics and morphine may have vasodilator effects, but specific vasodilators may be used (particularly intravenous glyceryl trinitrate or ISDN) provided the blood pressure is adequate.

Continuous positive airway pressure and bilevel positive airway pressure (BIPAP/NIPPV) has been demonstrated to reduce the need of mechanical ventilation in people with severe cardiogenic pulmonary edema, and may reduce mortality.

It is possible for cardiogenic pulmonary edema to occur together with cardiogenic shock, in which the cardiac output is insufficient to sustain an adequate blood pressure. This can be treated with inotropic agents or by intra-aortic balloon pump, but this is regarded as temporary treatment while the underlying cause is addressed.

References

External links

• HeartFailureMatters.org Animation showing How Heart Failure causes Fluid Accumulation - Created by the European Heart Failure Association

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 非心原性肺水腫 noncardiogenic pulmonary edema
• 2. 心原性肺水腫の病態生理 pathophysiology of cardiogenic pulmonary edema
• 3. 急性非代償性心不全の評価 evaluation of acute decompensated heart failure
• 4. 神経原性肺水腫 neurogenic pulmonary edema
• 5. 術後肺合併症のマネージメントの概要 overview of the management of postoperative pulmonary complications

English Journal

• Cannabinoid Receptor Type 2 Agonist Attenuates Acute Neurogenic Pulmonary Edema by Preventing Neutrophil Migration after Subarachnoid Hemorrhage in Rats.

• Fujii M1,2, Sherchan P1, Soejima Y1, Doycheva D1, Zhao D1, Zhang JH3.
• Acta neurochirurgica. Supplement.Acta Neurochir Suppl.2016;121:135-9. doi: 10.1007/978-3-319-18497-5_24.
• We evaluated whether JWH133, a selective cannabinoid type 2 receptor (CB2R) agonist, prevented neurogenic pulmonary edema (NPE) after subarachnoid hemorrhage (SAH) by attenuating inflammation. Adult male rats were assigned to six groups: sham-operated, SAH with vehicle, SAH with JWH133 (0.3, 1.0, or
• PMID 26463937

• Therapeutic Monoclonal Antibodies and Fragments: Bevacizumab.

• Klein A, Loewenstein A.
• Developments in ophthalmology.Dev Ophthalmol.2016;55:232-45. doi: 10.1159/000431199. Epub 2015 Oct 26.
• Bevacizumab (Avastin) is a recombinant humanized monoclonal immunoglobulin antibody that has two antigen-binding domains and blocks all active forms of vascular endothelial growth factor-A. It was originally designed and is still in use as antitumor agent (for colorectal and non-small cell lung canc
• PMID 26502311

• Acute respiratory failure in patients with hematological malignancies: outcomes according to initial ventilation strategy. A groupe de recherche respiratoire en réanimation onco-hématologique (Grrr-OH) study.

• Lemiale V1, Resche-Rigon M2, Mokart D3, Pène F4, Rabbat A5, Kouatchet A6, Vincent F7, Bruneel F8, Nyunga M9, Lebert C10, Perez P11, Meert AP12, Benoit D13, Chevret S14, Azoulay E15.
• Annals of intensive care.Ann Intensive Care.2015 Dec;5(1):28. doi: 10.1186/s13613-015-0070-z. Epub 2015 Sep 30.
• BACKGROUND: In patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients a
• PMID 26429355

Japanese Journal

• 患者,輸血製剤の双方に抗白血球抗体を検出した輸血関連急性肺障害の1症例

• 前川 謙悟,磯部 直史,藤本 昌史 [他]
• 麻酔 62(1), 92-94, 2013-01-00
• NAID 40019552106

• Protective effect of pre-recovery surfactant inhalation on lungs donated after cardiac death in a canine lung transplantation model.

• Ohsumi Akihiro,Chen Fengshi,Sakamoto Jin,Nakajima Daisuke,Hijiya Kyoko,Motoyama Hideki,Okita Kenji,Horita Kenta,Kikuchi Ryutaro,Yamada Tetsu,Bando Toru,Date Hiroshi
• The Journal of heart and lung
• … The lungs were flushed and procured, and the left lung was transplanted into recipient dogs. … At 45 minutes of reperfusion, the right pulmonary artery was ligated, and the left transplanted lung function was evaluated. … Furthermore, the SF group had higher levels of high-energy phosphates in the lung tissues and lower levels of interleukin-8, tumor necrosis factor-α, and protein in the bronchoalveolar lavage fluid. …
• NAID 120004874000

• 症例 小青竜湯が奏功した超巨大後腹膜腫瘍摘出後の難治性肺水腫の1例

• 斎藤 淳一,橋場 英二,丹羽 英智 [他]
• ICUとCCU : 集中治療医学 36(8), 607-611, 2012-08-00
• NAID 40019422201

Related Links

• Pulmonary edema - Wikipedia, the free encyclopedia

Pulmonary edema (American English), or oedema (British English; both words from the Greek οἴδημα), is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure.

• Pulmonary edema - MayoClinic.com

Pulmonary edema — Comprehensive overview covers symptoms, causes, treatment of this potentially life-threatening lung condition.

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