OEDEMA PULMO

AND ITS TREATMENT

Presented by :

Siti Chanifah
01.211.6529
1

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

 Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

2
<Change information classification in footer>

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

DO YOU KNOW?
Acute pulmonary oedema
is a life threatening
emergency

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

ACUTE PULMONARY OEDEMA

Accumulation of fluid in the
interstitial and alveolar
lung that occurs suddenly

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Normally, excess hydrostatic transudate

from pulmonary capillaries is filtered into
peribronchovascular lymphatics and
removed
Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Alveoli:

O2: Diffusion

from alveoli into

blood stream
capillary

CO2:

Diffusion
from blood
capillary into
alveoli
8

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

PO alv : 104 mmHG

PcO alv : 40 mmHG

PO cap : 40 mmHg

PcO cap : 46 mmHg

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Microvascular Fluid
Exchange in the Lung
Fluid and solutes that are filtered from the circulation into
Fluid and solutes that are filtered from the circulation into
the alveolar interstitial space
the alveolar interstitial space
Do not enter the alveoli because the alveolar epithelium is
Do not enter the alveoli because the alveolar epithelium is
composed of very tight junctions
composed of very tight junctions
It moves proximally into the peribronchovascular space
It moves proximally into the peribronchovascular space
The lymphatics remove most of this filtered fluid from the
The lymphatics remove most of this filtered fluid from the
interstitium and return it to the systemic circulation
interstitium and return it to the systemic circulation
10

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Microvascular Fluid Exchange

in the Lung
Increased hydrostatic pressure in the pulmonary capillaries
- elevated pulmonary venous pressure
- increased left ventricular end-diastolic pressure and left atrial
pressure

As left atrial pressure rises further (>25 mm Hg)

- edema fluid breaks through the lung epithelium
- flooding the alveoli with protein-poor fluid x`

11

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Microvascular Fluid
Exchange in the Lung
Noncardiogenic pulmonary edema
- increase in the vascular permeability of the
lung
- resulting in an increased flux of fluid and
protein into the lung interstitium and air
spaces

12

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

In hydrostatic edema,
transudate accumulates in
the interstitum initially, only
entering alveoli in severe
cases
In permeability edema
associated with diffuse
alveolar damage (DAD),
exudate fills the interstitum
and the alveoli

13

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Causes of Pulmonary Edema1

14

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Causes of Pulmonary Edema1

15

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

History

16

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

History

17

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Physical Examination

18

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Laboratory Testing
ECHO
BNP

XRAY
19

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Pulmonar
arterial
cateter

Laboratory Testing

BNP is secreted predominantly by the cardiac ventricles in

response to wall stretch or increased intracardiac
pressures

20

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Echocardiography
The first approach to assessing left ventricular and
valvular function in patients in whom the history,
physical and laboratory examinations, and the
chest radiograph do not establish the cause of
pulmonary edema

21

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Pulmonary-Artery Catheterization

Common complications included hematoma at

the insertion site, arterial puncture, bleeding,
arrhythmias, and bloodstream infection
22

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

23

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Hydrostatic and Permeability Edema

24

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Images courtesy of Dr. Marc Gosselin

ALOGARITM FOR
THE
CLINICAL
DIFFERENTIATION

25

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Hydrostatic Edema3
The lungs can accommodate increases in
fluid: the lymphatic flow can increase 3-10x
before edema develops
Higher hydrostatic pressures force fluid
through endothelial cell pores, but the tighter
junctions of epithelial cells prevent fluid from
entering alveoli until pulmonary capillary
pressures reach ~ 40 mm Hg, causing stress
failure

26

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Permeability Edema
Multiple insults can cause increased
pulmonary vessel permeability resulting
in leakage of fluid AND protein
In its most severe form, the disease is a
combination of vessel permeability and
DAD, leading to the acute respiratory
distress syndrome (ARDS)
Acutely, exudative edema in the alveoli
causes hyaline membrane formation
Type II epithelial cells then proliferate
and, usually, fibrosis occurs

27

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

A
L
O
G
A
R
I
T
H
M
28

40
-60
%
Sa TITR
O2
>9 ASI
0% S/D

a
Pa
,P
9900,
<
2< 0
o2 2<<660
ao
S
Sa o
o2

ide
ramide
lopram
toclop
metoc
+ me
mg+
Mo
4-8mg
rfin 4-8
Morfin
n
ern
san
p.p
afasa
de
ernafa
tau
p.p
pan
de
g,
tau
10m
pan
10mg,

110
0m
m

22,,55
IIN
N NIIT
T
n
an
M
M
N
A
E
assa
A /M
Siti Chanifah U
- TT01.211.6529
Medical Faculty of UNISSULA
ME
wa t
aaw
/
U
G
B
g
t
G
a
K
//K
ng etta
en
OB G
DO
P
D
EG
Pe kke
M
ME

ccg
g//m
me
en
niitt

replace tx. oral

OU <100ml/h dalam 1-2 h no adekuat

29

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA

Question??

30

Siti Chanifah - 01.211.6529 Medical Faculty of UNISSULA