Pulmonary edema

• Oedema

• 514 Pulmonary congestion and hypostasis
• 518.4 Acute edema of lung, unspecified
• PT diagnoses/treatment diagnoses that may be associated with respiratory disorders
  • 786.05 Shortness of breath
  • 780.7 Malaise and fatigue
  • 786.0 Dyspnea and respiratory abnormalities

• J81.0 Acute pulmonary edema
• J81.1 Chronic pulmonary edema

• 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders
• 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning
• 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated With Airway Clearance Dysfunction
• 6F: Impaired Ventilation and Respiration/Gas Exchange Associated With Respiratory Failure

Description

• Fluid accumulation in the air sacs/spaces and parenchyma of the lungs
• Respiratory failure
• Impaired gas exchange
• Peripheral edema
• Shortness of breath/difficulty breathing

Essentials of Diagnosis

• Sudden onset shortness of breath (dyspnea)
• Cyanosis
• Circulatory dysfunction
• Coughing up blood
• Pleural effusion

General Considerations

• Injury to the lung parenchyma
• Cardiac arrest secondary to lack of oxygen

Demographics

• Elderly, usually associated with heart failure, are most affected

Signs and Symptoms

• Difficulty breathing
• Fatigue
• Crackles
• Dyspnea
• Excessive sweating
• Anxiety
• Third heart sound
• Pale skin
• Pink sputum
• Diaphoresis
• Increased heart rate/tachycardia
• Cyanosis
• Rales
• Peripheral edema
• Wheezing
• Rhonchi

Functional Implications

• Decreased exercise tolerance
• Exercising at high altitude can worsen edema
• Inability to speak secondary to shortness of breath
• Disabling dyspnea when performing simple tasks (i.e., arm elevation to reach into cabinet)

Possible Contributing Causes

• Cardiogenic verse non-cardiogenic
• Acute myocardial infarction, heart attack
• Seizures
• Head trauma
• Kidney failure
• Electrocution
• Ischemia
• Congestive heart failure (CHF)
• Valvular regurgitation
• Mitral stenosis
• Opiod/heroin use
• Increased intracerebral pressure
• Sepsis
• Transfusion
• Exercising at high altitude

Differential Diagnosis

• CHF
• Influenza
• Cystic fibrosis
• Asthma
• Gastroesophageal reflux disease
• Bronchiectasis
• Kawasaki disease
• Bronchitis
• Upper respiratory tract infection
• Central airway obstruction
• Lung tumor
• Tuberculosis

Laboratory Tests

• Blood test for electrolytes
• Arterial blood gases
• Lung function tests
• Pulse oximetry
• Auscultation
• Percussion of the chest/lungs

Imaging

• Pulmonary capillary wedge pressure
• Pulmonary angiography
• Chest radiograph
• CT
• Lung ventilation/perfusion scan
• Echocardiogram

• Chest x-ray demonstrates interstitial and alveolar edema
• Crackle sound with auscultation

Medication

• Diuretic
• Morphine

• For imaging, x-ray
• To pulmonologist, for respiratory assessment

• Exercise limitation
• Shortness of breath
• Oxygen deprivation
• Limited endurance capacity

• Six-minute walk test for mild or non-symptomatic cases
• BORG Rating of Perceived Exertion (RPE)
• Monitor vital signs to include lung auscultations
• Short-Form 36 Health Survey (SF-36)
• New York Heart Association Functional Classification scale

• Oxygen
• Rest
• Fluid intake
• Smoking cessation
• Pulmonary rehabilitation (PR) to improve exercise capacity
• Inspiratory muscle training (IMT)
• Exercise (aerobic, strength, flexibility, posture, breathing) to return to prior level of function