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Noncardiogenic Pulmonary Edema

Noncardiogenic Pulmonary Edema. Alan Cheng AM Report 5/12/09. Starling Principle. Net Filtration = C x (Pcap – Pint) – (Ocap – Oint) Rate of lymphatic reabsorption. Permeability Problems. ARDS Bilateral infiltrates, hypoxia (P:F ratio), Wedge <= 18 Sepsis Aspiration Pneumonia

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Noncardiogenic Pulmonary Edema

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  1. Noncardiogenic Pulmonary Edema Alan Cheng AM Report 5/12/09

  2. Starling Principle • Net Filtration = C x (Pcap – Pint) – (Ocap – Oint) • Rate of lymphatic reabsorption

  3. Permeability Problems • ARDS • Bilateral infiltrates, hypoxia (P:F ratio), Wedge <= 18 • Sepsis • Aspiration • Pneumonia • Trauma or burns • TRALI – within 6 hours of completion of transfusion • Relief of upper airway obstruction • Lung/bone marrow transplant • Drugs/meds/alcohol

  4. Hydrostatic pressure problems • often due to cardiogenic pulmonary edema...) • PCWP > 18 • Volume overload – renal failure • Not hepatic failure or nephrotic syndrome

  5. Oncotic pressure problems • Hypoalbuminemia and nephrotic syndrome rarely cause nephrotic syndrome • Lung capillaries normally are more permeable, and therefore interstitial oncotic pressure is ~ 18, and body maintains this. Thus, drop in capillary oncotic pressure does not affect lungs, but does affect periphery. • Increased lymphatics in lungs • Nephrotic syndrome will cause pulmonary edema when combined another insult, eg increased L atrial pressures.

  6. Other causes of noncardiogenic pulmonary edema: • High altitude pulmonary edema • Neurogenic pulmonary edema • Reperfusion pulmonary edema • Reexpansion pulmonary edema • Opiate overdose • Salicylate toxicity • Pulmonary embolism • Viral infections

  7. Imaging www.med.yale.edu/intmed/cardio/imaging/findings/pulmonary_edema/index.html

  8. Imaging www.med.yale.edu/intmed/cardio/imaging/findings/pulmonary_edema/index.html

  9. Imaging • Mitral regurg • Right upper lobe Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Texas Heart Inst J, 2001;28(1):53-6.

  10. References • www.med.yale.edu/intmed/cardio/imaging/findings/pulmonary_edema/index.html • Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Tex Heart Inst J. 2001;28(1):53-6. • UpToDate • Cecil’s Essentials of Medicine, 6th ed, 2004

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