-
Anaesthesia Jun 1984Two young patients with head injuries subsequently developed neurogenic pulmonary oedema. The origin and pathways of the reflex response to cerebral trauma are...
Two young patients with head injuries subsequently developed neurogenic pulmonary oedema. The origin and pathways of the reflex response to cerebral trauma are discussed, with emphasis on the role of raised intracranial pressure and the sympathetic division of the autonomic nervous system in precipitating movement of systemic circulatory volume into the pulmonary circulation. Therapeutic measures are discussed which correct the progression of this condition by reducing intracranial pressure and blocking the systemic effects of autonomic reflex activity. This leads to the basis of a simple regime to treat future cases.
Topics: Acute Disease; Adolescent; Brain Injuries; Craniocerebral Trauma; Critical Care; Humans; Infant; Intracranial Pressure; Male; Pulmonary Edema; Respiration, Artificial
PubMed: 6742384
DOI: 10.1111/j.1365-2044.1984.tb07355.x -
JNMA; Journal of the Nepal Medical... Jul 2020Negative pressure pulmonary edema is an uncommon complication of the extubation of the endotracheal tube. An increase in intrathoracic pressure and negative pressure of...
Negative pressure pulmonary edema is an uncommon complication of the extubation of the endotracheal tube. An increase in intrathoracic pressure and negative pressure of the lung caused by acute laryngeal spasm results from acute upper respiratory obstruction causing life-threatening pulmonary edema by alveolar-capillary damage is called negative pressure pulmonary edema. We here describe 28-years old female case the preoperative diagnosis of pelvic inflammatory disease undergoing exploratory laporoscopy caused negative pressure pulmonary edema while extubation. With the immediate treatment, the patient was discharged without any abnormalities.
Topics: Adult; Airway Extubation; Airway Obstruction; Female; Humans; Intubation, Intratracheal; Laryngismus; Pressure; Pulmonary Edema
PubMed: 32827011
DOI: 10.31729/jnma.4970 -
Medical Ultrasonography Jun 2023Lung ultrasound (LUS) has been rapidly developed to evaluate pulmonary extravascular fluid. A systematic review was conducted to study the dynamic changes of LUS... (Meta-Analysis)
Meta-Analysis Review
AIMS
Lung ultrasound (LUS) has been rapidly developed to evaluate pulmonary extravascular fluid. A systematic review was conducted to study the dynamic changes of LUS findings of pulmonary congestion before and after hemodialysis and examine the application of LUS for the prognosis of hemodialysis patients.
MATERIAL AND METHODS
This study searched online databases for articles on hemodialysis patients that used LUS to evaluate dynamic changes during hemodialysis or prognosis. Articles published in English or Chinese until September 2021 with ≥30 patients were included in this study.
RESULTS
Of the 1329 articles, 14 met the inclusion criteria: 9 reported dynamic changes during dialysis in LUS (438 patients), and 5 reported the prognosis of hemodialysis patients in LUS (1274 patients). As indicated by a further meta-analysis, eight studies found that the combined standardized effect size was -0.74. The all-cause mortality rate of the dialysis patient group with high B-line scores was three times that of the dialysis patient group with low B-line scores. In dialysis patients, no difference was found between the LUS guided treatment and the conventional care in reducing the all-cause mortality (HR=0.92 95%CI: 0.67-1.27) and cardiovascular events (HR=0.98 95%CI: 0.72 -1.34).
CONCLUSIONS
LUS can be used to effectively evaluate the volume status of hemodialysis patients in real time. The level of B-line before dialysis is significantly correlated with the poor prognosis. However, compared with the routine nursing group, the treatment of hemodialysis patients with LUS-guided volume management cannot effectively reduce mortality and cardiovascular events.
Topics: Humans; Lung; Prognosis; Pulmonary Edema; Renal Dialysis; Ultrasonography
PubMed: 36191243
DOI: 10.11152/mu-3654 -
Critical Care (London, England) 2008Clearance of alveolar oedema depends on active transport of sodium across the alveolar-epithelial barrier. beta-Adrenergic agonists increase clearance of pulmonary...
INTRODUCTION
Clearance of alveolar oedema depends on active transport of sodium across the alveolar-epithelial barrier. beta-Adrenergic agonists increase clearance of pulmonary oedema, but it has not been established whether beta-agonist stimulation achieves sufficient oedema clearance to improve survival in animals. The objective of this study was to determine whether the increased pulmonary oedema clearance produced by intratracheal dopamine improves the survival of rats after mechanical ventilation with high tidal volume (HVT).
METHODS
This was a randomized, controlled, experimental study. One hundred and thirty-two Wistar-Kyoto rats, weighing 250 to 300 g, were anaesthetized and cannulated via endotracheal tube. Pulmonary oedema was induced by endotracheal instillation of saline solution and mechanical ventilation with HVT. Two types of experiment were carried out. The first was an analysis of pulmonary oedema conducted in six groups of 10 rats ventilated with low (8 ml/kg) or high (25 ml/kg) tidal volume for 30 or 60 minutes with or without intratracheally instilled dopamine. At the end of the experiment the animals were exsanguinated and pulmonary oedema analysis performed. The second experiment was a survival analysis, which was conducted in two groups of 36 animals ventilated with HVT for 60 minutes with or without intratracheal dopamine; survival of the animals was monitored for up to 7 days after extubation.
RESULTS
In animals ventilated at HVT with or without intratracheal dopamine, oxygen saturation deteriorated over time and was significantly higher at 30 minutes than at 60 minutes. After 60 minutes, a lower wet weight/dry weight ratio was observed in rats ventilated with HVT and instilled with dopamine than in rats ventilated with HVT without dopamine (3.9 +/- 0.27 versus 4.9 +/- 0.29; P = 0.014). Survival was significantly (P = 0.013) higher in animals receiving intratracheal dopamine and ventilated with HVT, especially at 15 minutes after extubation, when 11 of the 36 animals in the HVT group had died as compared with only one out of the 36 animals in the HVT plus dopamine group.
CONCLUSION
Intratracheal dopamine instillation increased pulmonary oedema clearance in rats ventilated with HVT, and this greater clearance was associated with improved survival.
Topics: Analysis of Variance; Animals; Dopamine; Lung Injury; Male; Pulmonary Edema; Random Allocation; Rats; Rats, Wistar; Respiration, Artificial; Survival Rate; Trachea
PubMed: 18331631
DOI: 10.1186/cc6829 -
Ugeskrift For Laeger May 2014Within the last decade the use of non-invasive ventilation has expanded. This article reviews the studies on non-invasive ventilation in the treatment of exacerbations... (Review)
Review
Within the last decade the use of non-invasive ventilation has expanded. This article reviews the studies on non-invasive ventilation in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary oedema, acute respiratory distress syndrome, asthma and neuromuscular disease. Its beneficial effect has primarily been found in exacerbations of COPD where it reduces mortality with a number needed to treat of ten when added to standard medical treatment. No other conclusive evidence of the superiority of non-invasive ventilation compared to other modalities has been shown.
Topics: Asthma; Humans; Neuromuscular Diseases; Noninvasive Ventilation; Pneumonia; Pulmonary Disease, Chronic Obstructive; Pulmonary Edema; Respiratory Distress Syndrome
PubMed: 25352004
DOI: No ID Found -
Medicine Feb 2020Diuretics are a commonly used for the treatment of acute pulmonary edema. However, inappropriate administration of diuretic drugs can result in clinical treatment...
INTRODUCTION
Diuretics are a commonly used for the treatment of acute pulmonary edema. However, inappropriate administration of diuretic drugs can result in clinical treatment failure and cause acute pulmonary edema. This is due to rapid decreases in intravascular volume as a result of diuretic treatment. To date, the clinical phenomenon of inappropriate use of diuretics leading to acute pulmonary edema remains unexplored and unrecognized. Here, we report the first case of this problem-pulmonary edema following diuretic therapy.
PATIENT CONCERNS
A 71-year-old male patient who was intubated and transferred to the intensive care unit (ICU) due to respiratory failure was initially diagnosed with pneumonia as a complication of acute respiratory distress syndrome (ARDS). After treatments including antibiotics, lung protective ventilation strategies, and restrictive fluid management, his respiratory symptoms improved. However, the patient's dyspnea became more severe after experimental diuretic therapy.
DIAGNOSIS
A point-of-care ultrasound (POCUS) examination showed increased extravascular lung water retention during a hypovolemic state. After full examinations and analysis, the diagnosis of acute pulmonary edema was determined.
INTERVENTIONS
The most likely cause of acute pulmonary edema was left ventricular (LV) hyperdynamic status due to a hypovolemic status caused by excessive diuretic therapy. Consequently, we administrated intravenous fluids and a β-receptor blocker to the patient.
OUTCOMES
Following these treatment, the patient's respiratory distress improved remarkably.
CONCLUSION
We report the first case of pulmonary edema following diuretic therapy to stress the need of physicians to follow guidelines of clinical practice. Maintaining an appropriate volume status and treatment of β-receptor blockers is the key to reversing the progress of this adverse effect. In this process, POCUS is a reliable diagnostic tool to identify the cause of acute pulmonary edema and can increase the accuracy of clinical evaluations. It is likely that a wider use of POCUS will help physicians to obtain a faster, and more accurate, diagnosis of the etiology of acute pulmonary edema, thus allowing a more appropriate therapy.
Topics: Aged; Diuretics; Extravascular Lung Water; Humans; Male; Pulmonary Edema
PubMed: 32080100
DOI: 10.1097/MD.0000000000019180 -
Postgraduate Medical Journal Oct 2005Non-invasive ventilation (NIV) is the delivery of assisted mechanical ventilation to the lungs, without the use of an invasive endotracheal airway. NIV has... (Review)
Review
Non-invasive ventilation (NIV) is the delivery of assisted mechanical ventilation to the lungs, without the use of an invasive endotracheal airway. NIV has revolutionised the management of patients with various forms of respiratory failure. It has decreased the need for invasive mechanical ventilation and its attendant complications. Cardiogenic pulmonary oedema (CPO) is a common medical emergency, and NIV has been shown to improve both physiological and clinical outcomes. From the data presented herein, it is clear that there is sufficiently high level evidence to favour the use of continuous positive airway pressure (CPAP), and that the use of CPAP in patients with CPO decreases intubation rate and improves survival (number needed to treat seven and eight respectively). However, there is insufficient evidence to recommend the use of bilevel positive airway pressure (BiPAP), probably the exception being patients with hypercapnic CPO. More trials are required to conclusively define the role of BiPAP in CPO.
Topics: Acute Disease; Continuous Positive Airway Pressure; Decision Making; Evidence-Based Medicine; Humans; Intermittent Positive-Pressure Ventilation; Pulmonary Edema; Pulmonary Gas Exchange; Randomized Controlled Trials as Topic
PubMed: 16210459
DOI: 10.1136/pgmj.2004.031229 -
The Journal of Craniofacial SurgeryNegative pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema that typically occurs in response to an upper airway obstruction, where patients...
Negative pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema that typically occurs in response to an upper airway obstruction, where patients generate high negative intrathoracic pressures, leading to a pulmonary edema especially in the postoperative period. Here, we report a case of NPPE following general anesthesia that can easily be misdiagnosed as COVID-19 both radiologically and clinically during this pandemic. Twenty-year-old male was presented with sudden onset respiratory distress, tachypnea, and cyanosis just after the rhinoplasty surgery under general anesthesia. Chest radiography and thoracic computed tomography scans revealed the bilateral patchy alveolar opacities with decreased vascular clarity that looks similar to COVID-19 radiology. Negative pressure pulmonary edema is a sudden onset and life-threatening complication following general anesthesia particularly after head and neck surgery in young healthy individuals. It is a clinical condition that cannot be diagnosed unless it comes to mind. While both NPPE and COVID-19 cause hypoxemia and respiratory distress, as well as ground-glass opacities in the chest computed tomography, those opacities in NPPE appear mostly in central areas, whereas those opacities are mostly seen in peripheral areas in COVID-19. Furthermore, while NPPE cause decreased vascular clarity, COVID-19 causes vascular dilatations in the areas of opacities. Those differences together with medical history of the patient is crucial to differentiate these 2 similar identities. Negative pressure pulmonary edema requires an immediate recognition and intervention, therefore, we would like to raise the awareness of clinicians for such condition to avoid possible mistakes during the pandemic situation.
Topics: Adult; COVID-19; Diagnosis, Differential; Humans; Male; Pandemics; Pulmonary Edema; SARS-CoV-2; Young Adult
PubMed: 33201071
DOI: 10.1097/SCS.0000000000007226 -
Tidsskrift For Den Norske Laegeforening... Jul 2004Heroin-induced pulmonary oedema is an infrequent complication to a heroin overdose; the incidence in Norway is unknown.
BACKGROUND
Heroin-induced pulmonary oedema is an infrequent complication to a heroin overdose; the incidence in Norway is unknown.
MATERIAL AND METHODS
One case is presented and pathophysiology, diagnosis and treatment are discussed.
RESULTS
Pulmonary oedema caused by the use of heroin may develop immediately or usually up to 1-2 hours after exposure. The symptoms usually resolve with supportive treatment within 1 or 2 days. Some patients require mechanical ventilation. The pathophysiology includes a rapid capillary leakage of unknown aetiology.
INTERPRETATION
Heroin use is widespread in Norway, and users are found all over the country. There are important differences between cardiogenic and heroin-induced pulmonary oedema regarding pathophysiology and treatment.
Topics: Adult; Drug Overdose; Heroin Dependence; Humans; Male; Pulmonary Edema; Radiography
PubMed: 15229662
DOI: No ID Found -
European Journal of Heart Failure Oct 2022
Topics: Humans; Morphine; Pulmonary Edema; Heart Failure; Acute Disease
PubMed: 36161434
DOI: 10.1002/ejhf.2698