Pulmonary edema in infectious diseases. How to help a patient - what you can and cannot do. What can you do

Acute pulmonary edema is a violation of blood and lymph circulation, which causes active release of fluid from the capillaries into the tissue of the said organ, which ultimately provokes a violation of gas exchange and leads to hypoxia. Acute edema grows quickly (the duration of the attack is from half an hour to three hours), which is why even with timely resuscitation efforts it is not always possible to avoid death.

How does acute pulmonary edema develop?

Acute pulmonary edema - the cause of death in many patients - develops as a result of infiltration into the lung tissue, where it accumulates in such quantities that the ability to pass air is greatly reduced.

Initially, the named edema has the same character as edema of other organs. But the structures that surround the capillaries are very thin, which is why fluid immediately begins to enter the cavity of the alveoli. By the way, she also appears in pleural cavities, however, to a much lesser extent.

Diseases that may cause acute pulmonary edema

Acute pulmonary edema is a cause of death in many diseases, although in some cases it can still be controlled with medication.

Diseases that can provoke pulmonary edema include pathologies of the cardiovascular system, including damage to the heart muscle due to hypertension, congenital defects and congestion V big circle blood circulation

No less common causes of pulmonary edema are severe skull injuries of various etiologies, as well as meningitis, encephalitis and various brain tumors.

It is natural to assume the cause of pulmonary edema in diseases or lesions such as pneumonia, inhalation of toxic substances, injuries chest, allergic reactions.

Surgical pathologies, poisoning, and burns can also lead to the described swelling.

Types of pulmonary edema

Patients most often experience two main, radically different types of pulmonary edema:

• cardiogenic ( cardiac edema lungs), caused by stagnation of blood in the lungs;
• noncardiogenic, caused by increased permeability, acute organ injury, or acute respiratory distress syndrome;
• toxic edema of the non-cardiogenic type is considered separately.

However, despite the fact that the causes of their occurrence are different, these edemas can be very difficult to differentiate due to similar clinical manifestations attack.

Pulmonary edema: symptoms

Emergency care provided in time for pulmonary edema still gives the patient a chance to survive. To do this, it is important to know all the symptoms of this pathology. They appear quite clearly and are easy to diagnose.

• At the beginning of an attack, the patient often coughs, his hoarseness increases, and his face, nail plates and mucous membranes become bluish.
• The suffocation intensifies, accompanied by a feeling of tightness in the chest and pressing pain. For relief, the patient is forced to sit and sometimes lean forward.
• The main signs of pulmonary edema appear very quickly: rapid breathing, which becomes hoarse and bubbling, weakness and dizziness appear. The veins in the neck area swell.
• When coughing, pink, foamy sputum is produced. And if the condition worsens, it can also be discharged from the nose. The patient is frightened and his consciousness may be confused. The limbs, and then the whole body, become wet from cold, sticky sweat.
• The pulse increases to 200 beats per minute.

Features of toxic pulmonary edema

A slightly different picture is presented by toxic pulmonary edema. It is caused by poisoning with barbiturates, alcohol, as well as the penetration of poisons into the body, heavy metals or nitric oxides. A burn of lung tissue, uremia, diabetes, can also provoke the described syndrome. Therefore, any severe attack of suffocation that appears in these situations should lead to suspicion of pulmonary edema. Diagnosis in these cases must be thorough and competent.

Toxic edema quite often occurs without characteristic symptoms. For example, with uremia, very scanty external signs in the form of chest pain, dry cough and tachycardia do not correspond to the picture visible on x-ray examination. The same situation is typical in toxic pneumonia and in the case of poisoning by metal carbonites. And nitrogen oxide poisoning can be accompanied by all the signs of edema described above.

First non-drug aid for pulmonary edema

If a patient has symptoms accompanying pulmonary edema, emergency care should be provided to him before being admitted to the intensive care unit. Necessary activities carried out by an ambulance crew on the way to the hospital.

Drug assistance for pulmonary edema

The variety of manifestations accompanying an attack has led to the use in medicine of many medications that can relieve acute pulmonary edema. The cause of death may lie not only in the pathological condition itself, but also in incorrectly selected treatment.

One of the medications used to relieve edema is morphine. It is especially effective if the attack was caused by hypertension, mitral stenosis or uremia. Morphine reduces shortness of breath by depressing respiratory center, relieves stress and anxiety in patients. But at the same time, it is capable of increasing intracranial pressure, which is why its use in patients with cerebrovascular accidents should be very careful.

To reduce hydrostatic intravascular pressure during pulmonary edema, Lasix or Furosemide are used intravenously. And to improve pulmonary blood flow, heparin therapy is used. Heparin is administered as a bolus (bolus) in a dose of up to 10,000 units intravenously.

Cardiogenic edema, in addition, requires the use of cardiac glycosides (“Nitroglycerin”), and non-cardiogenic edema requires glucocorticoids.

Severe pain is relieved with the help of the drugs Fentanyl and Droperidol. If the attack can be stopped, therapy for the underlying disease begins.

Pulmonary edema: consequences

Even if the relief of pulmonary edema is successful, treatment does not end there. After such an extremely difficult condition for the whole organism, patients often develop serious complications, most often in the form of pneumonia, which in in this case very difficult to treat.

Oxygen starvation affects almost all organs of the victim. The most serious consequences of this may be cerebrovascular accidents, heart failure, cardiosclerosis and ischemic organ damage. These conditions cannot be avoided without constant and enhanced drug support; despite the suppressed acute pulmonary edema, they are the cause of death in a large number of patients.

Pulmonary edema in humans is an immediate threat to life and urgent measures are required before hospitalization.

Why does swelling occur?

This pathological process is not an independent disease. He develops as a complication of an existing disease. Therefore, in order to avoid the occurrence of swelling, adequate treatment of all existing pathologies, especially those associated with the cardiovascular system, should be carried out.

The cause may be pathologies that are accompanied by ingestion of various kinds toxins. These include pneumonia and pleurisy, sepsis, as well as all types of poisoning (medicines, drugs, poisons, and so on). The pathological process in this case develops due to increased permeability of the alveolocapillary membrane.

Heart disease in the decompensation stage can result in the accumulation of fluid in the alveoli. This phenomenon occurs due to stagnation of blood in the pulmonary circulation. In capillaries lung tissue Pressure increases, which leads to swelling. In addition to heart pathologies, bronchial asthma and emphysematous expansion of lung tissue act in the same way.

Thromboembolism can lead to pulmonary edema pulmonary artery. It is a consequence of the detachment of a blood clot from blocked veins lower limb or after operations, when there is hypercoagulation in the blood.

The most common etiology of pulmonary edema is acute heart failure.

Also, the causes of this condition in adults can be those diseases in which there is a decrease in protein in the body. These include almost all kidney pathologies, as well as liver cirrhosis. By the same principle, swelling is provoked by intravenous transfusions of various solutions in large volumes.

Signs of the cardiogenic form

This type of edema is caused by acute heart failure. Pathology begins to develop at night or early in the morning. It is provoked by psychological and physical stress or other sudden changes in the body. A characteristic feature The cardiogenic form of the pathological process is a decompensated disorder of cardiac activity. When carrying out differential diagnosis, changes in the ECG and a decrease in ejection fraction are detected.

This type of pathology rarely affects children, and in adults the symptoms of pulmonary edema are as follows::

• increasing cough with mixed shortness of breath;
• attacks of suffocation;
• frequent shallow breathing (up to 60 breaths per minute);
• discharge of pinkish foam from the mouth;
• cyanosis of the fingers and nasolabial triangle (later spreads to the whole body);
• puffiness of the face;
• pulse is frequent but weak;
• profuse sweating;
• chest pain (increasing, may lead to shock);
• unstable pressure (usually elevated, but can become critically low).

Doctors can use auscultation to detect hard wheezing in a patient, which over time turns into moist wheezing of various sizes. When providing assistance, it is important to monitor blood pressure, which during pulmonary edema can drop so much that the heart stops. Doctors also stop the progression of hypoxia, which affects all internal organs, especially the brain.

Signs of a toxic form

The clinical picture of toxic damage has some features that make it possible to distinguish it from other forms. Only this type of swelling can be asymptomatic, detected using laboratory and instrumental methods. Toxic edema can occur in extensive and abortive forms.

The first signs of pulmonary edema are reflex disorders, in which patients note tearfulness, hacking cough, headaches, general weakness and dizziness. At this time, the risk of death from cardiac or respiratory arrest is high. Then there is a several hours of latent period of edema, during which there is no clinical signs, but the condition progressively worsens.

At the height of clinical manifestations, the following symptoms are noted:

• increased body temperature;
• cyanosis;
• shortness of breath and suffocation;
• cough with pink foam;
• bubbling breathing audible in the distance;
• moist rales on auscultation;
• cold extremities;
• thready pulse;
• critical drop in blood pressure.

This form of the pathological process is characterized by the presence of a period where there is a high risk of re-accumulation of fluid. This is due to the phenomena of heart failure, which can develop against the background of the first attack of edema. Therefore, toxic damage requires the longest observation in a hospital.

Features of the clinic in case of protracted course

Pulmonary edema can be divided into 4 main forms of course: acute (the peak occurs within 2-4 hours), subacute (up to 12 hours), fulminant (death within a few minutes) and prolonged.

With a protracted form of the pathological process, the increase in symptoms continues for more than a day.

This pulmonary edema manifests itself gradually, beginning to bother the patient with attacks of shortness of breath during physical exertion. Gradually the condition progresses, tachypnea develops. Breathing increases up to 40-50 times per minute. Patients complain of dizziness and general malaise. Over time, the clinical picture worsens and develops into typical symptoms of an acute pathological process.

However, already at the very beginning of fluid accumulation in patients, gurgling wheezing in the lungs can be heard. This indicates small quantity transudate in the alveoli. In addition, there are signs of pulmonary emphysema. If the doctor reacts at this stage of the development of the condition, he will be able to avoid taking many potent drugs and prevent serious hypoxia of the body.

A protracted course of the pathological process is typical for people with chronic diseases. For example, heart failure or kidney pathology. Gradually progressive liver cirrhosis also leads to slowly progressive pulmonary edema.

Diagnostic signs

First of all, swelling can be recognized by its typical clinical picture. You can also ask the patient or people nearby about the events that preceded the deterioration of the condition. It's important to know about serious illnesses patient. At the stage of emergency medical care, emergency measures begin without obtaining additional examination data.

Main criteria of the prehospital stage:

• percussion: dullness is detected;
• Auscultation: moist rales of various sizes;
• pulse measurement: weak filling, thready, frequent;
• pressure determination: above 140/90 or below 90/60 mm. rt. Art.

In bedridden patients, edema progresses faster, so treatment begins with simultaneous clinical studies.

Laboratory signs

First of all, the phenomena of hypoxia during edema are revealed by determining the partial pressure of oxygen and carbon dioxide. Then it is carried out biochemical analysis blood, which may indirectly indicate the etiology of edema. Biochemistry is also taken to clarify the diagnosis and confirm myocardial infarction if its presence is suspected. An important study is a coagulogram, which allows you to detect increased blood clotting and pulmonary embolism.

Instrumental signs

Most instrumental methods are aimed at identifying problems in the heart. These include: electrocardiography, echocardiography, and so on. In addition, using pulse oximetry, blood oxygen saturation is detected (if edema is below 90%).

Chest X-ray is the leading test for lung swelling. It is used to detect fluid in the lung tissue. Swelling can be bilateral or unilateral. Additionally, pulmonary artery catheterization can be performed, but this requires certain indications.

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In children, pulmonary edema is not independent disease, is always a complication of infectious, severe somatic or metabolic diseases. Pulmonary edema always occurs acutely; its main causes can be severe viral or microbial infections that affect both the lung tissue itself and the entire body as a whole, as well as small vessels(capillaries). Edema can also occur as a result of severe burns of a large surface of the body due to the fact that a lot of protein is lost. The loss of protein in the blood plasma leads to the fact that it cannot retain fluid inside the vessels; beks act as molecules that retain water. A reduced amount of protein leads to blood thinning and its passage through the pores of blood vessels into the tissue, including in the lung area, where blood circulation is especially active. Pulmonary edema may develop as a result of toxicosis, in which toxic substances damage the walls of blood vessels (create “holes” in them), through which fluid passes into the lung tissue.

Against the background of pneumonia, edema in the lungs forms due to severe inflammation, also due to damage to the walls of blood vessels by both microbes and toxins, and special substances (inflammatory mediators) that the body produces in response to infection.

Pulmonary edema can occur with some heart defects if blood circulation is redistributed after birth predominantly to the pulmonary circulation. As a result of excess blood in the vessels of the small circle, the blood pressure in it sharply increases. Which leads to the “pushing” of fluid into the tissue from the vessels.

Symptoms

Initially, symptoms from those problems that cause pulmonary edema may dominate, and relatively minor swelling of the lung tissue may occur without significant symptoms. This is due to the fact that the lung tissue has sufficient reserve for breathing and gas exchange. As edema increases inside the lungs, shortness of breath forms; in children, the chest muscles actively tense and participate in breathing, a wet cough with sputum develops, cyanosis of the hands and feet, and face ( nasolabial triangle). From a distance, you can hear wheezing in the lungs, noisy and heavy breathing, the formation and discharge of sputum from the mouth with an abundance of foam.

Noisy breathing may occur with attacks of respiratory arrest, the chest expands and swells, the intercostal spaces may be drawn inward, and the sub- and supraclavicular fossae are also drawn in. When listening to the lungs, one can hear weakened breathing and a variety of wet rales.

There is a change in the boundaries of the heart, its sounds are invited, tachycardia and arrhythmias, systolic heart murmurs are determined, the size of the liver changes, and a general edematous syndrome is expressed. Foamy discharge from the mouth or nose may turn pink.

Diagnosis of pulmonary edema in a child

The basis of diagnosis is the serious condition of the child and clinical manifestations; an x-ray of the lungs is necessary to clarify the diagnosis. X-rays reveal typical changes in the pulmonary pattern and reveal the degree of edema. Fluid may be detected in the pleural cavity and the boundaries and dimensions of the heart may change. I also determine the gas composition of the blood, which contains an excess of carbon dioxide with a deficiency of oxygen, which decreases when breathing oxygen. The entire course is conducted laboratory tests blood to identify the cause of edema and the degree of metabolic disorder associated with it.

Complications

The main complication of pulmonary edema is the death of a child from respiratory failure, as well as the formation of irreversible changes in the lungs. Heart failure, liver damage and severe brain hypoxia with irreversible brain damage and disability are also dangerous.

Treatment

What can you do

Pulmonary edema - emergency, self-medication at home is unacceptable; immediate hospitalization in an intensive care unit is necessary.

What does a doctor do

Therapy is carried out in intensive care, methods are used to eliminate the immediate causes of edema - treatment of pneumonia with antibiotics or antiviral agents depending on the cause, in case of cardiac pathology - maintenance therapy until the swelling is eliminated and treatment and surgery are possible.

Oxygen therapy using a mask or endotracheal tube, positive expiratory oxygen pressure, and, if necessary, transferring the child to artificial ventilation are indicated. The flow of fluid into the child’s body is limited to the minimum possible. The use of diuretics, maintaining heart function with the help of medications, vascular drugs to reduce wall permeability. Hormones may also be prescribed.

All therapeutic measures depend on the severity of the edema, age and condition of the baby.

Prevention

The main prevention of pulmonary edema is timely and complete treatment of all bronchopulmonary pathologies, inpatient treatment of pneumonia, especially in children early age, monitoring the condition of children with heart defects and their prompt correction whenever possible and as soon as it becomes possible.

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Pulmonary edema- this is a complication various diseases, which is excessive transudate leakage into the interstitial tissue and then into the pulmonary alveoli. The term pulmonary edema is used to describe a complex of clinical symptoms resulting from the accumulation of fluid in the pulmonary parenchyma.

According to the etiopathogenetic principle, two forms of pulmonary edema are distinguished: hydrostatic (occurs as a complication of diseases accompanied by an increase in hydrostatic pressure in the lumen of blood vessels) and membranous (occurs due to the damaging effect of toxins of various origins on the capillary-alveolar membrane).

The incidence of hydrostatic pulmonary edema is much higher due to the fact that the pathology of the cardiovascular system prevails in the general morbidity of the population. The risk group for this pathology is people over 40 years of age, but pulmonary edema can also occur in children with accompanying left ventricular failure.

The lungs are an organ that supplies all cells and tissues of the human body with oxygen. With pulmonary edema, total hypoxia occurs, which is accompanied by the accumulation of carbon dioxide in the tissues.

Pulmonary edema causes

Pulmonary edema is not an independent nosological form, but is a complication of a number of diseases.

Among the main causes of pulmonary edema should be considered:

- acute intoxication syndrome, due to the ingestion of infectious and non-infectious toxins into the body infectious origin(septic condition, bacterial macrofocal pneumonia, excess accumulation medicines, poisoning narcotic substances poisons). Toxins have a damaging effect on alveolocapillary membranes and promote the release of transudate from the pulmonary interstitium;

— chronic lung diseases (COPD, emphysema, macrofocal pneumonia, malignant neoplasms in the lungs);

- pulmonary edema as a result of rapid ascent over a long distance (more than 3 km);

- unilateral pulmonary edema as a result of rapid evacuation of fluid or air from the pleural cavity (with pneumothorax and exudative pleurisy);

- diseases accompanied by a decrease in blood oncotic pressure as a result of a decrease in protein (nephrotic syndrome, cirrhosis of the liver, chronic hemorrhagic syndrome);

- uncontrolled excessive infusion of liquid medications by intravenous infusion in combination with impaired renal excretory function;

- traumatic injury to the chest, accompanied by pneumothorax;

- severe traumatic brain injury accompanied by convulsive activity;

- the occurrence of pulmonary edema in diseases that occur with increased intracranial pressure(acute cerebrovascular accident, tumor lesion brain)

- long-term artificial ventilation with high concentration oxygen;

- aspiration syndrome in case of drowning, getting caught foreign body or vomit into the respiratory tract.

Depending on the root cause of pulmonary edema, there is a classification that distinguishes cardiogenic and non-cardiogenic (neurogenic, nephrogenic, allergic, toxic) forms of edema.

The pathogenetic mechanisms of any form of pulmonary edema consist of several stages. The onset of pulmonary edema is the interstitial stage, during which transudate accumulates in the pulmonary interstitium. At this stage they arise. Then the liquid containing a high percentage of protein moves to the alveoli and beats it with air, resulting in the formation of a viscous foam. Due to its thick consistency, the foam obstructs the airways and acute respiratory failure occurs, which causes the accumulation of carbon dioxide in the tissues (hypercapnia), decompensated acidosis and hypoxia. All of the above metabolic disorders can cause irreversible processes in life important organs and end in death.

There are three pathomorphological mechanisms of pulmonary edema:

1. A sharp increase in hydrostatic pressure.

2. Decrease in blood oncotic pressure.

3. Damage to the protein structure of the membrane located between the alveolus and the capillary and increased alveolar permeability.

In any form of pulmonary edema, a violation of the alveolar capillary wall occurs, resulting from damage to the protein-polysaccharide complex of the membrane. For pulmonary edema resulting from anaphylactic shock, severe intoxication infectious nature, inhalation of vapors of toxic substances and severe renal failure, this pathogenetic mechanism is leading in the development of manifestations of pulmonary edema.

As a result of the combination of increased hydrostatic pressure with decreased oncotic pressure, conditions are created for an increase in filtration pressure in the lumen of the pulmonary capillaries. The cause of this condition is most often the uncontrolled intravenous infusion of hypoosmotic solutions without taking into account daily diuresis. In addition, in severe renal and liver failure There is a deficiency of protein in the blood, which helps to reduce oncotic pressure.

Among the pathogenetic causes of acute cardiogenic pulmonary edema, sharp increase hydrostatic pressure in the pulmonary bloodstream, aggravated by the fact that the outflow of blood to the left side of the heart is difficult (myocardial infarction, mitral stenosis).

Pulmonary edema symptoms

Clinical manifestations of pulmonary edema depend on the stage of the disease and on the speed of transition from the interstitial to the alveolar form. According to the statute of limitations, they distinguish: acute pulmonary edema (symptoms of alveolar edema develop within a maximum of 4 hours), prolonged (symptoms of edema increase gradually and reach a maximum after a few days) and fulminant, which in almost 100% of cases ends in death due to extremely serious condition sick.

The causes of acute pulmonary edema are transmural myocardial infarction and mitral stenosis at the stage of decompensation. A subacute variant of the development of pulmonary edema is observed in renal failure, infectious lesion pulmonary parenchyma. A prolonged form of edema is characteristic of chronic inflammatory diseases localized in the lung tissue.

The fulminant variant is observed in cardiogenic pulmonary edema, which is accompanied by widespread cardiac pathology ( massive heart attack myocardium,). In the subacute form, the first symptom of pulmonary edema is shortness of breath with physical activity, which gradually increases and transforms into suffocation.

In practice, emergency doctors medical care They use a clinical classification of pulmonary edema, in which 4 stages are distinguished: the dyspnea stage (massive dry rales throughout the lung fields and the absence of wet rales), the orthopnoetic stage (prevalence of wet rales over dry), the stage of pronounced orthopnea (wet rales are heard at a distance without use phonendoscope), manifesting stage (bubbling breathing, pronounced skin, copious discharge of foamy sputum).

A feature of interstitial pulmonary edema is its occurrence at night against the background of complete well-being. Excessive physical activity or psycho-emotional stress may be a provoking factor. A harbinger of the development of edema is coughing at night.

Symptoms of the interstitial phase of pulmonary edema: shortness of breath with minimal physical activity and at rest, decreasing when the patient sits, a sharp lack of air and the inability to do deep breath, and general malaise.

At primary visual inspection draws the patient's attention severe pallor and increased moisture of the skin, combined with cyanosis of the nasolabial triangle and surface of the tongue, exophthalmos. Lung percussion reveals symptoms of acute emphysema in the form of a box sound.

Auscultatory changes in the lungs - bronchial type of breathing with a mass of dry wheezing wheezing throughout the lung fields on both sides. From the side of cardiovascular changes, a rapid heartbeat is noted, the first tone is weakened at all auscultatory points, and an accent of the second tone is noted in the projection of the pulmonary trunk. X-ray examination visualizes the lack of structure and expansion of the roots of the lungs, unclear pulmonary pattern, a uniform symmetrical decrease in pneumotization and the presence of Kerley lines in the basal-lateral segments of the lungs.

Symptoms of the alveolar phase of pulmonary edema grow very intensely and suddenly, so they are difficult for patients to tolerate. The patient experiences a sharp increase in shortness of breath up to suffocation, frequency breathing movements increases to 40 per minute, noisy stridor breathing and cough with copious discharge foamy sputum mixed with blood (in a short period of time the patient produces up to 2 liters of foamy sputum). Unlike interstitial edema, when patients choose a forced position and try not to even move, in the phase of alveolar edema the patient is extremely agitated. On external examination, diffuse cyanosis of the skin of the face and torso, decreased blood pressure and increased pulse rate, and swelling of the veins in the neck are noted. Auscultatory changes - a mass of moist rales of various sizes throughout the entire lung fields, and tachypnea, heart sounds cannot be heard due to noisy breathing. X-ray skiology: homogeneous bilateral extensive darkening in the hilar region with fuzzy uneven contours and infiltrative changes in the lungs of varying extent and shape.

In the acute period, there is an increase in heart rate up to 160 beats per minute and an increase in blood pressure, and with protracted current and increasing hypoxia, a weakening of the pulse, a decrease in blood pressure and an increase in respiratory movements are observed, despite the fact that breathing becomes shallow.

Pulmonary edema can have a wave-like course, when, after stopping the attack, a relapse of clinical manifestations occurs, therefore all patients require qualified medical care in a hospital setting.

Toxic pulmonary edema is accompanied by a fulminant course and, in most cases, death. Signs of edema increase within a few minutes, and acute respiratory failure ends in complete cessation of breathing due to nitrogen oxide poisoning. And at the same time, toxic pulmonary edema caused by uremia may have a slight clinical symptoms and a bright x-ray picture.

Clinical manifestations of pulmonary edema can occur in other diseases, so it is necessary to carry out careful differential diagnosis with such pathologies as: pulmonary embolism, status asthmaticus with bronchial asthma, acute coronary syndrome. In some cases, there is a combination of pulmonary edema with the above diseases.

Pulmonary edema in bedridden patients

The pathogenetic mechanism of pulmonary edema in a bedridden patient is due to the fact that horizontal position the volume of air inhaled is significantly less than when breathing in a vertical position. As a result of a decrease in the activity of respiratory movements, lung volume decreases, blood flow decreases, and congestive changes occur in the pulmonary interstitium. Conditions are created for the accumulation of sputum containing an inflammatory component. The discharge of sputum is difficult, and therefore congestive changes in the lungs intensify.

Against the background of all the above pathogenetic changes, congestive pneumonia occurs, a complication of which is pulmonary edema in the absence of adequate therapy.

A feature of pulmonary edema in bedridden patients is the gradual appearance and increase of clinical symptoms. The primary complaint of such patients is unmotivated increased breathing and increasing shortness of breath, which patients describe as a feeling of lack of air. Due to the gradual increase in hypoxia, oxygen starvation brain, which manifests itself in the form of drowsiness, dizziness, weakness. Despite the paucity of clinical manifestations, an objective examination reveals disturbances in the form of the presence of moist coarse rales throughout the lung fields with a maximum of lower parts, as well as dullness of pulmonary sound during percussion.

In order to prevent the occurrence of pulmonary edema, all bedridden patients are recommended to perform breathing exercises twice a day - blowing air through a tube into a container of water, inflating balloons.

To avoid stagnation in the pulmonary circulation, all bedridden patients are advised to lie in bed with the head end elevated, which is why most inpatient wards are equipped with special functional couches.

In bedridden patients, fluid accumulation is possible not only in the lung tissue, as evidence of pulmonary edema, but also in the pleural cavities (hydrothorax, exudative pleurisy). In this situation, the use of therapeutic puncture is indicated, after which most patients note a significant improvement in their condition.

Pulmonary edema first aid

Relief of pulmonary edema should occur on prehospital stage, and hospitalization in the intensive care unit must be carried out after stabilization of the patient’s condition. In a situation where it is not possible to stabilize the patient’s condition, and respiratory symptoms increase, it is necessary to transport the patient as carefully as possible to a specialized hospital to provide more qualified care. It is recommended that all resuscitation measures to stabilize hemodynamic parameters.

To determine the necessary emergency measures, one should take into account not only the existing symptoms, but also the type of edema according to the pathogenetic criterion. However, there is a certain algorithm for emergency measures that is followed for all types of pulmonary edema.

It is necessary to provide the patient with a supply of fresh air and give the patient a semi-sitting position. All constrictive clothing in the upper half of the body should be removed from the patient. The most effective and in a fast way bloodletting is used to reduce pressure in the pulmonary circulation system. The volume of recommended blood extraction is 300 ml and significantly reduces congestive changes in the lungs. Contraindications to the use of this method are arterial hypotension and poorly defined veins.

An alternative to bloodletting can be the application of venous tourniquets to “unload” the pulmonary circulation. When applying a tourniquet, you should check the pulsation of the arteries below the level of the tourniquet so as not to stop the arterial blood flow. You should not leave the venous tourniquet in place for more than an hour and change limbs once every 20 minutes. An absolute contraindication for applying a tourniquet is. Hot foot baths are used as distraction procedures.

Urgent medication assistance for pulmonary edema, perform the following program:

- maintenance therapy through immediate adequate oxygenation, tracheal intubation, mechanical ventilation at a rate of 16-18 per minute and a volume of insufflated air of 800-900 ml. Oxygen therapy refers to the continuous inhalation of 100% humidified oxygen through nasal cannulas. The criterion for adequate blood oxygenation in the lungs in the absence of direct monitoring of oxygen transport and consumption should be a combination of oxygenation indicators arterial blood at the level of 70-80 mmHg, and venous blood at the level of 35-45 mmHg;

- reduction of intravascular hydrostatic pressure by using diuretics (Lasix 4-6 ml solution intravenously or Furosemide 40-60 mg intravenously);

- suction of fluid from the upper respiratory tract using an aspirator;

- use of defoamers: inhalation of a 30% ethyl alcohol solution, intravenous infusion of 5 ml of 96% ethyl alcohol together with 15 ml of a 5% glucose solution, and in case of strong foam secretion, the endotracheal route of administration of 2 ml of 96% ethyl alcohol by tracheal puncture is used;

- heparin therapy is indicated to normalize pulmonary blood flow (bolus administration of Heparin in a dose of 6000-10000 units intravenously, then switch to subcutaneous administration of low molecular weight heparins - Fraxiparin 0.3 ml twice a day);

- if there is severe pain, then it is necessary to administer Fentanyl (2 ml of 0.005% solution) to the patient with Droperidol (4 ml of 0.25% solution) in 10 ml isotonic solution sodium chloride;

- Morphine (1 ml of 1% solution intravenously) is used to eliminate excitation of the respiratory center. For cardiogenic pulmonary edema, Morphine is a pathogenetic agent and is used in all patients. Side effects Morphine causes vomiting, so its administration is recommended to be combined with intramuscular administration of 1 ml of Diphenhydramine or Pipolfen;

— in case of depression of the respiratory center, which is accompanied by Cheyne-Stokes type breathing, intravenous administration of Euphyllin in a dosage of 10 ml of a 2.4% solution is indicated. The administration of Eufillin is accompanied by a decrease in blood pressure, which is important for cardiogenic edema with hypertension, but when prescribing Eufillin it should be taken into account side effects in the form of tachycardia and increased oxygen demand of the heart muscle;

- parenteral administration of corticosteroids (Hydrocortisone 125 mg per 150 ml of 5% glucose solution) is used to improve the condition of the pulmonary membrane;

- antihistamines (Diphenhydramine 1 ml of 1% solution intramuscularly, Suprastin 1 ml of 2% solution intravenously);

Emergency measures to relieve acute cardiogenic pulmonary edema have their own characteristics and are aimed at reducing preload on the heart, improving contractile function myocardium and “unloading” of the pulmonary circulation.

To reduce preload on the heart, it is necessary to reduce blood flow from peripheral vessels into the pulmonary circulation, for which peripheral vasodilators are used (Nitroglycerin in various dosage forms - Nitrospray, tablets with a frequency of 1 tablet every 10 minutes, intravenous infusion of a 0.01% solution at a rate of 1 ml of solution in 4 minutes).

For cardiogenic edema, the use of 1% Morphine solution in a dose of 1 ml intravenously is indicated, since this drug has a wide range medicinal properties: vagotropic effect, as a result of which the overexcited respiratory center is inhibited, dilating effect on the pulmonary and peripheral veins, ganglion-blocking properties, allowing to reduce blood flow into the pulmonary circulation system. If there are contraindications to the use of Morphine (bronchospastic syndrome, signs of cerebral edema), the drug of choice is Droperidol (2 ml of 0.25% solution intravenously).

To improve the contractile function of the myocardium, the administration of Dopamine at a dosage of 2 mcg/kg/min with rheopolyglucin intravenously is indicated. TO adverse reactions Dopamine administration includes: paroxysmal tachycardia, vomiting and increasing shortness of breath.

To “unload” the pulmonary circulation, it is necessary to reduce the volume of circulating fluid and the pressure in the pulmonary artery. For this purpose, diuretic drugs of the saluretic group are used (Furosemide 40-100 mg). The use of osmodiuretics is absolutely contraindicated, since these drugs increase pulmonary edema.

Volume infusion therapy should be reduced to 200-300 ml of 5% glucose.

With a pronounced concomitant bronchiolospastic component (expiratory shortness of breath, hard breathing heard on auscultation), there is a need to administer Prednisolone at a dose of 30-60 mg intravenously.

Cardiogenic pulmonary edema is often associated with acute disorders rhythm of cardiac activity, in connection with which electrical pulse therapy or electrical stimulation can be performed.

The use of drugs that have a stabilizing effect on the increased permeability of cell membranes is indicated (Contrical 40-60 thousand units intravenously).

When cardiogenic pulmonary edema is combined with increased blood pressure, the emergency algorithm consists of: intravenous infusion of Nitroglycerin (30 mg per 300 ml saline solution sodium chloride) with an injection rate of 10 drops per minute under constant monitoring of blood pressure, intravenous administration of 1 ml of a 5% solution of Pentamin, and in case of severe arterial hypertension - 1 ml of a 0.01% solution of Clonidine.

Pulmonary edema treatment

After providing first emergency aid and stabilizing the patient’s condition, the patient is taken to the department intensive care where treatment continues. The main criteria for patient transportability include: respiratory rate less than 22 per minute, absence of foamy sputum, absence of moist rales during auscultation of the lungs, absence of cyanosis of the skin, stabilization of hemodynamic parameters.

In a hospital setting, after a thorough medical examination, conditions are created to identify the etiological factors that were the root cause of pulmonary edema.

Among the diagnostic measures, the following should be highlighted: biochemical blood test with mandatory determination of the level total protein and creatinine to assess kidney function, a blood test for troponins to diagnose acute coronary syndrome and myocardial infarction, determination of blood gas composition, coagulogram for suspected pulmonary embolism.

Intensive care wards are equipped diagnostic equipment, in connection with which it is possible to conduct instrumental research methods - pulse oximetry to determine blood oxygen saturation, phlebotonometry to measure venous pressure in the subclavian vein, radiography of the chest cavity to determine the stage of edema and possible complications, electrocardiography for diagnosing pathology of cardiac activity.

After establishing the cause of pulmonary edema, etiological treatment is prescribed, for example, toxic pulmonary edema, requires detoxification therapy, and in some cases the introduction of an antidote, and in case of pulmonary edema against the background of macrofocal pneumonia, the use of antibacterial agents is indicated.

Treatment measures in the intensive care unit are carried out under constant monitoring of hemodynamic indicators and parameters external respiration. The administration of most medications is carried out through central venous access, for which the resuscitator performs catheterization of the subclavian vein.

For successful treatment any form of pulmonary edema great importance has a psycho-emotional state of the patient, therefore all patients are recommended to undergo calming and sedative therapy using a 1% Morphine solution in a dose of 1 ml intravenously.

In the intensive care unit, treatment of pulmonary edema continues with the use of medications aimed at improving the functioning of the cardiovascular system and improving metabolic processes in the myocardium.

To improve the contractile function of the myocardium in a patient with pulmonary edema that arose against the background of a hypertensive crisis and insufficiency mitral valve, the prescription of cardiac glycosides in a therapeutic dose is justified (Korglikon 1 ml of 0.06% solution intravenously). A contraindication to the use of cardiac glycosides is acute heart attack myocardium.

In the intensive care unit, oxygen therapy in combination with the use of antifoam agents, as well as the use of diuretics and peripheral vasodilators, continues. Defoaming is carried out using several methods: 95% is poured into the humidifier ethanol and oxygen is supplied through it at a rate of 3 liters per minute, which is gradually increased to 7 liters per minute. On average, after 20 minutes of the procedure, severe breathing problems and moist rales in the lungs disappear. An effective defoamer that stops an attack of pulmonary edema within 3 minutes is 10% alcohol solution Antiphomsilane, which is sprayed into a humidifier.

The appearance of recurrent pulmonary edema is an indication for surgical treatment diseases accompanied by severe heart failure ( surgical correction heart defects, excision of aortic aneurysm).

Pulmonary edema consequences

Due to the fact that pulmonary edema provokes the development of respiratory failure, the phenomena of hypoxia increase in the human body. Prolonged hypoxia leads to irreversible destructive processes in the cells of the central nervous system and directly adversely affects the structures of the brain. Damage to the central nervous system may manifest as autonomic disorders, not life-threatening to the patient, but the lesion is vital important structures brain leads to fatal outcome.

Despite modern methods diagnosis and treatment, mortality from alveolar pulmonary edema is at high level and reaches 50%, and cardiogenic pulmonary edema in combination with acute myocardial infarction leads to death in 90% of cases. In this regard, it is very important for the successful relief of clinical manifestations of edema. timely diagnosis and qualified and individual approach to prescribe a particular treatment. Stopping an attack at the stage of interstitial edema improves the prognosis for the patient.

To avoid severe complications recommended preventive actions to prevent pulmonary edema - timely diagnosis and treatment of pathologies of the cardiovascular system, maintenance chronic diseases lungs at the compensation stage, preventing contact with allergens and toxins chemical origin, smoking cessation and following a diet with limited salt intake.

Long-term consequences of pulmonary edema are congestive pneumonia, pulmonary fibrosis and segmental atelectasis. In addition, as a result of prolonged hypoxia and hypercapnia, conditions are created for ischemic damage to all organs and systems.

In order to avoid severe complications of pulmonary edema, there are recipes traditional medicine, which have positive effects in preventing re-edema. For this purpose, a decoction of flax seeds and cherry stalks is used. The frequency of taking this decoction is 4 times a day for at least three months. It should be borne in mind that taking traditional medicine can cause allergic reaction which negatively affects the healing process.

To avoid serious consequences pulmonary edema, you should know what the signs, causes and methods of treatment are this state in patients. This pathology is characterized by impaired pulmonary gas exchange and the development of oxygen deficiency in the blood. In this case, hypoxia itself is accompanied by damage to the alveolocapillary membranes, which leads to their high permeability - the first stage of pulmonary edema.

What is pulmonary edema

Pathological condition caused by increased levels tissue fluid, called pulmonary edema. Lung pathology occurs in 2 stages:

1. Interstitial edema is infiltration of serous fluid into the lung tissue. At this stage, hypoxia develops, ensuring high permeability of the alveolo-capillary membrane.
2. Alveolar stage – the appearance of fluid in the alveoli, which contributes to the development of the pathological process.

Symptoms

Swelling of the airways appears suddenly and develops quickly. TO clinical symptoms diseases in adults include:

• intense shortness of breath (attack of cardiac asthma), especially after prolonged exposure to a horizontal position;
• frequent, bubbling, shallow breathing that can be heard from a distance;
• cough with moist wheezing and pink sputum;
• instant feeling of lack of air - attacks of suffocation;
• compressive, pressing pain in the chest, worsening in a horizontal position (lying on your back);
• pale or blue skin;
• abundant sticky sweat;
• cardiopalmus;
• agitation of the patient;
• increased body temperature;
• confusion or coma.

Pulmonary edema in children

Symptoms of pulmonary edema in a child appear clearly, so it is easy to recognize the pathology. Children have a cough with prolonged wheezing, they begin to choke, especially in a horizontal position, thick sputum appears with pink tint. In addition, the child refuses to eat, sleeps poorly and behaves restlessly due to chest pain. Older children about this pain syndrome They say. When fluid is retained in the lungs, parents notice gusty breathing and pale skin which may turn blue and become sweaty. You also need to pay attention to an increased heart rate.

Causes

What causes pulmonary edema? There are many reasons for the development of lung pathology. They are associated with cardiology, pulmonology, nephrology and other areas of medicine. So, the causes of pulmonary edema may be the following:

• cardiosclerosis;
• acute myocardial infarction;
• heart failure;
• arrhythmia;
• congenital dropsy;
• Chronical bronchitis;
• tuberculosis;
• cirrhosis of the liver;
• acute pancreatitis;
• acute laryngitis;
• ARVI;
• flu.

In older people

Main reason pulmonary disease in elderly patients there is blood stagnation, which develops due to prolonged lying down. Signs of congestion are similar to symptoms of respiratory failure. Other reasons for the development of the pathological condition include:

• long-term use of drugs with salicylates;
• blood transfusion;
• infectious diseases that affect respiratory system;
• reaction to the introduction of protein substances.

In bedridden patients

In a horizontal position, much less air enters the body than in a vertical position. Due to the fact that breathing activity is reduced, blood flow in the lungs decreases and congestion occurs. Thus, sputum accumulates, the expectoration of which in a horizontal position is difficult - the process of stagnation progresses. In addition, sputum contains components that cause inflammation. The gradual development of pulmonary edema is typical for many bedridden patients.

Types of pulmonary edema

Depending on the causes of the pathology, experts distinguish 2 types of pulmonary edema:

• Cardiogenic edema. Pathology appears due to heart failure. To determine cardiogenic edema, the capillary pressure of the lungs is measured, which for this type exceeds 30 mm. rt. Art. The attack most often occurs at night and is accompanied by severe pain in the chest, unstable blood pressure and others clinical signs mentioned above. At this phase of cardiogenic edema, the rate of development of pathology is higher than in other cases, so there is less time to provide assistance.
• Non-cardiogenic edema. It develops due to the high permeability of the pulmonary vessels and the penetration of fluid into the internal cavity of the lungs. Thus, with a large amount of liquid, the functioning of blood vessels significantly deteriorates, and gas exchange is disrupted. After relief, it is very important to find the cause, which is difficult, since the pathology manifests itself due to diseases of the kidneys, liver, lungs and many other conditions.

Non-cardiogenic pulmonary edema also has subtypes, which can be used to describe the patient’s condition in more detail in order to use suitable treatment:

• Toxic. Pathology develops after toxic gases or vapors enter the lower respiratory tract. After the first minutes of toxic damage, respiratory arrest and cardiac arrest may occur.
• Cancerous. Appears in the background malignant tumor lungs. The lymph nodes become clogged, causing edematous fluid to accumulate in the alveoli.
• Allergic. Pathology occurs due to contact with an allergen - after an insect bite, blood transfusion, etc. If therapeutic measures are not taken in a timely manner, it may occur anaphylactic shock.
• Neurogenic. The occurrence of pathology occurs due to spasm of the veins. This results in high hydrostatic pressure of blood within the pulmonary capillaries, which flows through the lung cells and into the alveoli.

In addition to classification by pathogenesis, pulmonary edema is distinguished by the course of the condition. So, the following forms are distinguished:

• lightning;
• protracted;
• spicy;
• I'll tweak it.

Complications

The disease is very severe pathological condition which requires timely treatment. If you do not meet the deadlines or carry out therapeutic measures incorrectly, the following may occur: dangerous complications:

• fulminant form of the disease;
• respiratory depression;
• cardiogenic shock;
• unstable hemodynamics;
• asystole;
• blockage of the airways.

Diagnostics

In order to diagnose pulmonary edema, several measures are carried out. The main ones include following methods examinations:

• collecting complaints about symptoms of lung pathology;
• general examination of skin tissue, listening to the lungs, measuring blood pressure and pulse;
• chest x-ray;
• establishing blood gas composition;
• saturation of the bloodstream with oxygen.

Treatment

The treatment strategy for the pathology is to eliminate the causes and signs of pulmonary edema in order to alleviate the patient’s condition. Doctors do the following:

• oxygen is supplied to the lungs through ethyl alcohol;
• reduce the load on the heart and pressure in the pulmonary capillaries;
• eliminate edematous fluid from the lungs;
• normalize cardiac output;
• after urgent therapeutic measures, the underlying disease is treated;
• To prevent a recurrent attack, antibiotics are prescribed.

Urgent Care

If you notice symptoms of pulmonary edema, you should immediately call doctors, and before their arrival, first aid for pulmonary edema is carried out. You should:

• open windows or otherwise provide fresh air;
• give to the patient exalted position and warm his feet;
• Allow the patient to breathe in alcohol vapor.

While performing the above actions, it is necessary to constantly monitor the patient’s pulse and breathing. Upon arrival, doctors will provide emergency treatment to reduce the load on the circulatory and respiratory systems, normalize pressure and reduce foaming:

1. The patient will have foam removed from his mouth to restore breathing. For this purpose, use clean gauze or a swab.
2. Tourniquets are placed on the upper thigh to reduce blood flow to the heart.
3. They do oxygen therapy - treatment with oxygen. In this case, the patient inhales an increased concentration of air.
4. To stop foaming, oxygen is inhaled through alcohol.
5. To reduce the pressure inside the pulmonary vessels, injections are given or medications are given orally.
6. IN severe cases artificial ventilation is required.
7. After emergency care is provided, the patient is taken to the hospital.

Drugs

If pulmonary edema develops due to heart disease, to normalize high blood pressure and if there are signs of myocardial ischemia, nitrates are used. A representative of this group is Nitroglycerin, which quickly relieves ischemic attacks and angina. Contraindications include: hypersensitivity, head injuries, pregnancy and breastfeeding (breastfeeding). With low blood pressure, the patient is given drugs to increase heart contraction - the stimulant Dobutamine.

To remove excess fluid from the body, diuretics or diuretics are used. Lasix is ​​a “loop” diuretic drug that enhances the excretion of water and increases the excretion of potassium, magnesium, and calcium. The drug is contraindicated in serious illnesses kidneys and liver, increased central venous pressure, hypersensitivity to furosemide.

For symptoms of bronchospasm, take steroid hormones. One of them is Prednisolone, which has anti-inflammatory, antiallergic, and glucocorticoid effects. The drug has practically no contraindications - only the presence of fungal infections and increased sensitivity to the components of the drug.

Defoamers

By effective means To eliminate foaming during pulmonary edema, antifoam agents are used. Their action is to increase the surface tension of the liquid, which helps stop the formation of hemorrhagic foam. The main defoaming agents include ethyl alcohol. Air or oxygen is passed through 30-90% ethanol, after which the patient breathes it. If alcohol turns out to be ineffective, Antifomsilan solution is used.

Main complications after emergency care

After emergency care, the patient may experience complications. The main ones include:

• respiratory depression;
• increased pulmonary edema due to high blood pressure;
• asystole;
• tachyarrhythmia;
• development lightning-fast form;
• airway obstruction;
• inability to normalize blood pressure;
• anginal pain.

Consequences

Pulmonary edema contributes to the creation favorable conditions to defeat internal organs . Thus, the consequences of lung pathology are varied:

• pneumonia;
• pulmonary atelectasis;
• pneumosclerosis;
• emphysema;
• hypoxia;
• cerebrovascular accident;
• cardiosclerosis;
• heart failure;
• ischemic lesion organs or systems of the body;
• gas exchange disorders;
• acidosis;
• death.

Prognosis and prevention

Survival after surgery pulmonary disease accounts for 50% of cases, while most patients have abnormalities in the body. If you do not see a doctor in the clinic for the next year and do not cure the cause of the lung pathology, the probability of relapse is 100%. Only the right therapeutic measures can ensure a positive prognosis. If you want to avoid similar pathology, prevention should be carried out:

• timely treatment of chronic diseases;
• healthy lifestyle;
• compliance with safety rules when working with toxic substances;
• limiting alcohol consumption;
• compliance with drug dosages.

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