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20.10 Pulmonary Oedema

Table of Contents

Diagnostic Criteria

Common cause of pulmonary oedema are cardiac/fluid overload, and th common causes are;

Systolic heart failure complicating fluid overload

  • Renal failure complicating fluid overload
  • Iatrogenic fluid overload

Other Cause of pulmonary oedema

  • Increased capillary permeability Acute Respiratory Distress Syndrome (ARDS); many causes include; Systemic sepsis–gram negative infection, pancreatitis, head injury, aspiration of gastric contents, amniotic embolus

Non-Pharmacological Treatment

Initial management

  • Maintain airway, bed rest in Fowler`s position except if hypotensive or comatose
  • Administer oxygen to keep PO2 > 60 mmHg (O2 saturation > 90%)
  • Correct base–acid & electrolyte disorders, determine and correct arrhythmias,

Pharmacological Treatment

Cardiac failure

B: Furosemide 20mg–80mg IV, may be repeated in 10–15 minutes

  • If symptoms persist, morphine 1–3mg IV diluted form,
  • Inotropic support if hypotensive SBP < 90mmHg–dobutamine 2–20 μg/kg/min
  • Intravenous vasodilator nitroglyceride if SBP > 100mmHg.

Non–cardiac (ARDS)

  • Treat the underlying conditions
  • Ventilate with PEEP – if RF
  • Inotropic support if SBP<90mmHg
  • Dialysis if renal fail

Referral

All patients suspected pulmonary oedema should be referred to high level of care where hospital resourced with high care dependent unit or intensive care unit hospital. Patient should be stabilized first at low level of care before referral to the high level of care

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