Noncardiogenic Pulmonary Edema

Noncardiogenic Pulmonary Edema is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Noncardiogenic pulmonary edema (NCPE) occurs secondary to accumulation of excess fluid and protein into the alveoli from factors other than increased pulmonary capillary pressure >18 mm Hg
  • Permeability pulmonary edema:
    • Functional disruption of the capillary–alveolar membrane allows protein and fluid to move freely from the intravascular space into the alveolar space
  • Pulmonary parenchymal changes are similar to CHF
  • Concomitant CHF may occur in up to 20% of patients with acute respiratory distress syndrome (ARDS)
  • Distinction between NCPE and CHF:
    • Pulmonary capillary pressure ≤18 mm Hg
    • Often apparent from the clinical circumstances
    • The concentration of protein in the alveolar fluid is identical to that of the intravascular space in patients with NCPE
    • Cephalad redistribution of blood flow, pulmonary effusions, and cardiomegaly are usually not present
  • Adult respiratory distress syndrome:
    • Clinical presentation caused by permeability pulmonary edema
    • Associated with severe physiologic impairment
  • Typically, onset of the edema is within 1–2 hr of the noxious insult.
  • ∼250,000 cases occur each year in US

Etiology

  • ARDS is the #1 cause:
    • Caused by:
      • Sepsis
      • Pneumonia
      • Nonthoracic trauma
      • Inhaled toxins
      • Disseminated intravascular coagulation (DIC)
      • Radiation pneumonitis
  • High-altitude pulmonary edema (HAPE) neurogenic pulmonary edema
  • Narcotic overdose
  • Pulmonary embolus
  • Eclampsia
  • Transfusion-related acute lung injury (TRALI)
  • Re-expansion of a collapsed lung in patient with a pneumothorax
  • Salicylate intoxication
  • Inhaled cocaine use
  • Near drowning
  • HCTZ
  • Uremia
  • S/p cardiopulmonary bypass; especially if patient taking amiodarone

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