Pulmonary Edema - Research Paper Example

?Pulmonary Edema Overview Edema means swelling in general terms. Swelling happens as a result of outward seepage of fluid contained in the blood vessels into the surrounding tissues. This normally happens because of buildup of excessive pressure inside the blood vessels. Insufficiency of proteins in the bloodstream is another reason of swelling because proteins cannot hold on to the plasma’s fluid. Pulmonary edema is the name of a condition that is caused as a result of excessive accumulation of fluid inside the lungs. Lungs inhale oxygen and the carbon dioxide is passed for exhalation into the alveoli. This exchange of air takes place in a thin wall of the alveoli. This wall helps keep fluids out of the alveoli. “In the healthy lung, intravascular and interstitial hydrostatic and plasma oncotic pressures are relatively balanced, resulting in minimal fluid flux into the interstitium and alveoli” (Fleisher and Ludwig, 2010, p. 1079). Pulmonary edema is caused by alterations in the changes or pressures in the permeability of lung membranes that exchange the fluid. The patient experiences problem in breathing when the numerous air sacs inside lungs get filled by this fluid. Acute pulmonary edema is a medical emergency in which the patient needs immediate care. Pathophysiology Different factors can cause pulmonary edema. These factors may be related to cardiogenic pulmonary edema caused by heart failure or to non-cardiogenic pulmonary edema. Pulmonary edema is caused by heart problems in most cases. Poor heart function causes high blood pressure inside the lungs. Congestive heart failure, abnormal heart valves, and heart attacks can be the cause of accumulation of excess blood in the lungs’ blood vessels. The consequential buildup of pressure causes fluid to be expelled from the blood vessels into the alveoli. However, there can be other reasons for the accumulation of fluid inside the lungs as well that include but are not limited to exposure to medications and toxins, pneumonia, living at high elevation, and exercising. Non-cardiogenic pulmonary edema is caused by factors including kidney failure, acute respiratory distress syndrome (ARDS), high altitude pulmonary edema, brain trauma, brain surgery, severe seizures, overdose of methadone or heroin, and overdose of aspirin. “Patients with acute or chronic renal failure may develop pulmonary edema because of increased pulmonary capillary hydrostatic pressure” (Brant and Helms, 2007, p. 419). Underlying causes of pulmonary edema are essentially its risk factors. No risk factor can be identified specifically for pulmonary edema besides those for the conditions causing the disease. Signs and Symptoms Shortness of breath is the most common symptom, which is also known as breathlessness. In case of slow development of pulmonary edema, onset of breathlessness is gradual, but it is rapid when an individual has acute pulmonary edema. Other symptoms of pulmonary edema include experience of dyspnea upon exertion, easy fatigue, tachypnea, weakness, and dizziness. Patients of pulmonary edema also complain of low level of oxygen in the blood. In addition, when lungs of the patient are examined with the help of a stethoscope, abnormal lung sounds like crackles and rales are audible. Diagnosis and Treatment An individual who is diagnosed with this condition should seek medical attention. The patient particularly needs to be hospitalized in the case of acute pulmonary edema. On the other hand, patients with chronic pulmonary edema see their doctors routinely. In a vast majority of cases, pulmonologists, cardiologists, or internal medicine doctors or internists treat pulmonary edema. Chest X-ray is used to diagnose pulmonary edema. Normal X-ray of chest shows a central white area for the heart, vertebral column, and main blood vessels whereas there are darker fields on both sides showing lung fields, enclosed in chest wall’s bony structures. In a chest X-ray of the patient of pulmonary edema, both lung fields consist of larger white appearance. Significant opacification with minimal visualization can be noticed in more severe cases. Identification of the factors that have caused pulmonary edema in a certain case requires thorough evaluation of the clinical picture of that individual. Information gathered just from physical examination and medical history of an individual is often incomplete. Measurement of N-terminal pro-BNP or B-type natriuretic peptide (BNP) are some of the diagnostic tools employed for the identification of the cause of pulmonary edema. Some of the tests performed to diagnose pulmonary edema include blood chemistries, chest x-ray, blood oxygen levels, echocardiogram to gauge problems in the heart muscle, and electrocardiogram (ECG) to assess the signs of heart attack (nlm.nih.gov, 2013). Treatment Pulmonary edema is fatal at times. However, if the patient gets prompt treatment for this condition along with the underlying problem’s treatment, chances of improvement of the outlook are maximized. While the treatment of pulmonary edema is different for different patients depending upon the cause of the condition, treatment generally involves providing the patient with medications and supplemental oxygen. Treatment of pulmonary edema is dependent upon the cause of the condition and the level of severity of the condition. In a vast majority of cases, diuretics are prescribed to the patient along with certain medicines to control heart failure. In most cases, it is possible to get appropriate treatment by taking oral medications as an outpatient. Hospitalization may be needed if pulmonary edema is more severe. Therapeutic Treatment Non-invasive ventilation is an effective therapeutic treatment for pulmonary edema when given along with efficient medical interventions. The combination of non-invasive ventilation and medical interventions can deter the necessity of endotracheal intubation in most patients. This therapeutic treatment is directed at quick restoration of arterial oxygenation in addition to cardiac function’s medical support i.e. by diuretics, ACE-inhibitors, and nitrates etcetera to improve the delivery of myocardial oxygen and reduce the consumption of oxygen. Mechanical Ventilation An effective treatment method for pulmonary edema is mechanical ventilation. A mechanical ventilator helps patients breathe till the time they can breathe independently by themselves (American Thoracic Society, 2013). Mechanical ventilators range from machines that are just respirators to machines that help patients breathe with a mouthpiece or a mask. Although they offer many life-saving benefits, yet there are certain risks associated with the use of mechanical ventilators. This imparts the need to finish the patient’s dependence on the mechanical ventilator as soon as possible. The quality of ventilation is affected by the position of body. Patients in prone position that are given mechanical ventilation show improved ventilation-perfusion mismatches. “Changing the inspiratory-to-expiratory ratio from the normal 1:3 timing to one in which the ratio is closer to 1:1 has been shown to maintain higher constant airway pressures which enhances oxygenation” (Perina, 2003, p. 390). Prevention Although prevention of pulmonary edema cannot be fully guaranteed, yet chances of preventing pulmonary edema are maximized if an individual adopts a healthy lifestyle. People who suffer from another disease which is likely to develop pulmonary edema in them at a later point in time need to consult their healthcare providers and seek advice so as to take measures to minimize the chances of occurrence of pulmonary edema. Diet and exercise helps reduce the risk of pulmonary edema to a great extent. An individual that maintains a well balanced and healthy diet, and does regular workout in order to maintain the ideal body weight with respect to their height and age has much lower risk of developing pulmonary edema in comparison to an individual who is overweight or obese and does not maintain a healthy diet schedule. High altitude pulmonary edema can be prevented by maintaining a slow ascent in which the average altitude gain remains under 300 m/d over a 2500 m altitude (Maggiorini, 2010, p. 500). References: American Thoracic Society. (2013). Mechanical Ventilator. Retrieved from http://www.thoracic.org/clinical/critical-care/patient-information/icu-devices-and-procedures/mechanical-ventilator.php. Brant, W. E., and Helms, C. A. (2007). Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. Fleisher, G. R., and Ludwig, S. (2010). Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins. Maggiorini, M. (2010). Prevention and Treatment of High-Altitude Pulmonary Edema. Progress in Cardiovascular Diseases. 52, 500-506. nlm.nih.gov. (2013). Pulmonary edema. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000140.htm. Perina, D. G. (2003). Noncardiogenic pulmonary edema. Emergency Medicine Clinics of North America. 21, 385-393. Read More