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    Noncardiogenic Pulmonary Edema

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

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    Emergency Central

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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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    Citation

    Rosen, Peter, et al., editors. "Noncardiogenic Pulmonary Edema." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307008/all/Noncardiogenic_Pulmonary_Edema.
    Noncardiogenic Pulmonary Edema. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307008/all/Noncardiogenic_Pulmonary_Edema. Accessed April 23, 2019.
    Noncardiogenic Pulmonary Edema. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307008/all/Noncardiogenic_Pulmonary_Edema
    Noncardiogenic Pulmonary Edema [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307008/all/Noncardiogenic_Pulmonary_Edema.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Noncardiogenic Pulmonary Edema ID - 307008 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307008/all/Noncardiogenic_Pulmonary_Edema PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -