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Journal of Veterinary Emergency and... 2023To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations...
OBJECTIVE
To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality.
DESIGN
Retrospective study.
SETTING
University teaching hospital.
ANIMALS
Thirty dogs and 1 cat, all client owned.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03).
CONCLUSIONS
NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation.
Topics: Cats; Dogs; Animals; Pulmonary Edema; Retrospective Studies; Cat Diseases; Dog Diseases; Airway Obstruction
PubMed: 37087613
DOI: 10.1111/vec.13290 -
The American Journal of Emergency... Jan 2023Sympathetic crashing acute pulmonary edema (SCAPE) is a medical emergency in which severe, acute elevation in blood pressure results in acute heart failure and fluid...
BACKGROUND
Sympathetic crashing acute pulmonary edema (SCAPE) is a medical emergency in which severe, acute elevation in blood pressure results in acute heart failure and fluid accumulation in the lungs. Without prompt recognition and treatment, the condition often progresses rapidly to respiratory failure necessitating intubation and intensive care unit (ICU) admission. In addition to non-invasive positive pressure ventilation (NIPPV), high-dose nitroglycerin (HDN) has become a mainstay of treatment; however, an optimal dosing strategy has not been established.
OBJECTIVE
The purpose of this study was to describe the characteristics and outcomes of patients who received an HDN infusion (≥ 100 μg/min) for the management of SCAPE in the Emergency Department (ED) of a large urban academic medical center. Outcomes were also analyzed to determine predictors of safety and efficacy including use of adjunct medication therapies.
RESULTS
There were 67 adult patients who received HDN infusion for SCAPE from January 1, 2018 to December 31, 2018. The median (IQR) systolic blood pressure (SBP) on initiation of HDN infusion was 211 (192-233) mmHg. Patients were 63% male, 84% black, 51% had a history of heart failure (HF), and 36% had end-stage renal disease (ESRD). IV nitroglycerin (NTG) was initiated at a median (IQR) dose of 100 (100-200) mcg/min with median (IQR) peak rate in the first hour of 200 (127.5-200) mcg/min and an absolute maximum observed rate of 400 μg/min overall. 73% of patients received NIPPV, 48% sublingual (SL) or IV bolus nitroglycerin before HDN infusion, 58% loop diuretic, and 34% angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB). Rates of ICU admission, intubation, acute kidney injury (AKI) at 48 h, and hypotension were 37%, 21%, 13%, and 4% respectively.
CONCLUSION
This is the largest to date study describing the use of an HDN infusion (≥100 μg/min) strategy for the management of SCAPE. HDN infusion may be a safe alternative strategy to intermittent bolus HDN.
Topics: Humans; Male; Female; Pulmonary Edema; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Heart Failure
PubMed: 36327753
DOI: 10.1016/j.ajem.2022.10.018 -
Transfusion Jul 2019Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and...
BACKGROUND
Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI.
STUDY DESIGN AND METHODS
An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases.
RESULTS
In the redefinition, the term "possible TRALI" has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies.
CONCLUSIONS
Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.
Topics: Blood Transfusion; Consensus; Female; Humans; Male; Pulmonary Edema; Risk Factors; Transfusion-Related Acute Lung Injury
PubMed: 30993745
DOI: 10.1111/trf.15311 -
The Medical Clinics of North America Mar 2016Individuals may seek the advice of medical providers when considering travel to high altitude. This article provides a basic framework for counseling and evaluating such... (Review)
Review
Individuals may seek the advice of medical providers when considering travel to high altitude. This article provides a basic framework for counseling and evaluating such patients. After defining "high altitude" and describing the key environmental features at higher elevations, the physiologic changes that occur at high altitude and how these changes are experienced by the traveler are discussed. Clinical features and strategies for prevention and treatment of the main forms of acute altitude illness are outlined, and frameworks for approaching the common clinical scenarios that may be encountered regarding high-altitude travelers are provided.
Topics: Altitude Sickness; Brain Edema; Humans; Pulmonary Edema; Risk Factors; Travel
PubMed: 26900119
DOI: 10.1016/j.mcna.2015.09.002 -
The American Journal of Emergency... Jul 2018Negative pressure pulmonary edema (NPPE) is a clinical syndrome well described in the literature and easy to recognize in cases of suspicion, but probably...
Negative pressure pulmonary edema (NPPE) is a clinical syndrome well described in the literature and easy to recognize in cases of suspicion, but probably underdiagnosed. It can be a cause of morbidity and admission to the intensive care unit of healthy young individuals. It is present in approximately one in every thousand anesthetics and in 10% of the episodes of upper airway obstruction that are observed in routine clinical practice. It is a non-cardiogenic form of pulmonary oedema thought to be caused by the highly negative intra-thoracic pressure generated when trying to breathe against an acute obstruction. We report a case of NPPE after an airway obstruction in a young male patient.
Topics: Adult; Airway Obstruction; Animals; Fishes; Foreign Bodies; Humans; Male; Pharynx; Pulmonary Edema; Radiography, Thoracic
PubMed: 29602671
DOI: 10.1016/j.ajem.2018.03.056 -
Cleveland Clinic Journal of Medicine Jun 2022
Topics: Humans; Pulmonary Edema
PubMed: 35649566
DOI: 10.3949/ccjm.89c.06001 -
Cleveland Clinic Journal of Medicine Mar 2022
Topics: Humans; Pulmonary Edema
PubMed: 35232823
DOI: 10.3949/ccjm.89a.21046 -
Interactive Cardiovascular and Thoracic... Jul 2022
Topics: Humans; Pleural Effusion; Pneumothorax; Pulmonary Edema
PubMed: 35751602
DOI: 10.1093/icvts/ivac170 -
Nature Reviews. Disease Primers Jun 2024Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude... (Review)
Review
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
Topics: Humans; Altitude Sickness; Altitude; Acclimatization; Brain Edema; Pulmonary Edema; Hypertension, Pulmonary; Hypoxia
PubMed: 38902312
DOI: 10.1038/s41572-024-00526-w -
Critical Care Medicine Aug 2015Neurogenic pulmonary edema is an underrecognized and underdiagnosed form of pulmonary compromise that complicates acute neurologic illness and is not explained by... (Review)
Review
OBJECTIVE
Neurogenic pulmonary edema is an underrecognized and underdiagnosed form of pulmonary compromise that complicates acute neurologic illness and is not explained by cardiovascular or pulmonary pathology. This review aims to provide a concise overview on pathophysiology, epidemiology, clinical characteristics, impact on outcome and treatment of neurogenic pulmonary edema, and considerations for organ donation.
DATA SOURCES
Database searches and a review of the relevant medical literature.
STUDY SELECTION
Selected studies included English-language articles concerning neurogenic pulmonary edema using the search terms "neurogenic" with "pulmonary oedema" or "pulmonary edema," "experimental neurogenic pulmonary edema," "donor brain death," and "donor lung injury."
DATA EXTRACTION
Selected studies were reviewed by both authors, and data extracted based on author consensus regarding relevance for this review.
DATA SYNTHESIS
Existing evidence is organized to address: 1) pathophysiology, 2) epidemiology and association with different neurologic diseases, 3) clinical presentation, 4) impact on outcome, 5) treatment, and 6) implications for organ donation after brain death.
CONCLUSIONS
Neurogenic pulmonary edema occurs as a complication of acute neurologic illness and may mimic acute lung injury of other etiology. Its presence is important to recognize in patients due to its impact on clinical course, prognosis, and treatment strategies.
Topics: Diagnosis, Differential; Fluid Therapy; Humans; Hypoxia; Nervous System Diseases; Prognosis; Pulmonary Edema; Respiration, Artificial
PubMed: 26066018
DOI: 10.1097/CCM.0000000000001101