Description

Fluid accumulation in the tissue and air spaces of the lungs causing impaired gas exchange and respiratory failure due to either failure of the left ventricle to remove blood adequately from pulmonary circulation or to an injury to the lung parenchyma or vasculature of the lung leading to inflammation and impaired gas exchange

• Cardiogenic:
  • High pulmonary capillary pressure results in inadequate removal of fluid from the pulmonary circulation and inadequate tissue perfusion
  • Most frequent cause of pulmonary edema
• Noncardiogenic:
  • Increased alveolar–capillary membrane permeability and accumulation of fluid in the alveoli without a cardiac etiology
  • Acute respiratory distress syndrome (ARDS):
    • Bilateral pulmonary opacities: On ultrasound and chest x-ray
    • Symptoms not explained by cardiac etiology or volume overload
    • Severity dictated by PaO₂/FiO₂ ratio of ≤300 mm Hg with <100 mm Hg implying severe disease
    • May be caused by many different systemic pathologies ranging from sepsis to pancreatitis

Etiology

• Cardiogenic etiologies:
  • Systolic heart failure also known as heart failure with reduced ejection fraction, or HFrEF:
    • Ischemic heart disease
    • Dilated cardiomyopathy
    • Takotsubo cardiomyopathy
    • Cardiac dysrhythmias
    • Sepsis with myocardial stunning
    • Myocarditis
    • Myocardial contusion
  • Diastolic heart failure also known as heart failure with preserved ejection fraction, or HFpEF:
    • Hypertrophic cardiomyopathy
    • Restrictive cardiomyopathy
    • Pericardial effusion or tamponade
    • Cardiac arrhythmias
  • Pressure overload:
    • Mitral or aortic stenosis
    • Severe hypertension
  • Volume overload:
    • Mitral or aortic regurgitation
    • Missed dialysis or acute renal failure
    • Blood transfusions or IV fluid
  • High-output heart failure:
    • Thyrotoxicosis
    • Anemia
    • Arteriovenous fistula
    • Wet beriberi
    • Sepsis
  • Congenital or rheumatic heart disease
  • Endocarditis
• Noncardiogenic etiologies:
  • Negative pressure pulmonary edema:
    • Upper airway obstruction
    • Reexpansion pulmonary edema
  • Neurogenic pulmonary edema:
    • Seizure
    • Head trauma (open or closed)
    • Subarachnoid hemorrhage
  • Systemic:
    • Sepsis
    • Pneumonia
    • Pancreatitis
    • Disseminated intravascular coagulation
    • Uremia
    • Malignancy
  • Other:
    • Inhalation or aspiration
    • Pulmonary contusion
    • Narcotic or medication overdose
    • Naloxone-induced
    • Immersion pulmonary edema
    • ARDS
    • High-altitude pulmonary edema
    • Hantavirus pulmonary syndrome
    • Strangulation or electrocution