Acute pulmonary edema: A dangerous condition that requires special attention

Acute pulmonary edema is a very serious condition that directly threatens the patient's life if not promptly intervened and treated. With proper and aggressive management, a person's life can be dramatically saved. How to identify this state? Who needs to pay special attention to prevention and how to handle it when it happens? Let's follow this article together to understand more about it.

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• 1. What is acute pulmonary edema?
• 2. Causes of acute pulmonary edema
• 3. Symptoms of pulmonary edema
• 4. What should be done when the patient has acute pulmonary edema?
• 5. Treatment methods
• 6. What should be done to prevent the day situation from happening.

1. What is acute pulmonary edema?

Normally, the lungs receive blood from the heart, and then exchange it with oxygen obtained from the air. This gas exchange is vital to the individual and the body will respond in many ways to make this process as smooth as possible.

Acute pulmonary edema is a condition caused by the patient's lungs becoming "fluid". It is important to distinguish the common concept of "hydrophilic lung" that people outside the medical profession often use in another pathology, which is pleural effusion .

Patients with acute pulmonary edema have fluid retention in the interstitial spaces and alveoli of the lung. It can be temporarily understood that this fluid is stasis in the lumen and the interstitial spaces between the "pockets" of the lungs. Fluid stagnation in the lumen will interfere with the normal gas exchange between the blood and the air. Congestion in the interstitial spaces compresses and collapses the exchange sacs (alveoli). All of which lead to the end result being severely impaired respiratory function. And death is certain, otherwise the condition does not improve quickly.

Image depicting the lungs of a patient with pulmonary edema. Above is a normal alveolar sac, below is a picture of the alveolar sac filled with fluid due to pulmonary edema.

2. Causes of acute pulmonary edema

Fluid in the lungs will be affected by both factors:

• Blood is pumped by the heart to the lungs (specifically, the right heart). At the same time, the heart also dilates to collect blood.
• The pressure exerted by molecules capable of holding water (called colloidal pressure). Formed mainly by the concentration of the protein albumin in the blood.
• Alveolar–capillary membrane integrity (A multi-layered membrane formed between the lung structure and blood vessels). Factors that increase the permeability of the membrane, making it easier for fluid to "spill into the lungs".

This condition is therefore divided into two different types of pulmonary edema, with many distinct causes, characteristics, and treatment.

2.1 Hemodynamic pulmonary edema

It is so called due to the stasis of blood and fluid in the Lungs due to many different causes or a combination. The amount of blood or fluid entering and leaving the lungs is primarily responsible for the heart. Therefore, cardiovascular diseases are an important cause of this condition. In addition, equally important is the role of the kidneys in purifying and regulating fluids in the body. Patients with severe renal failure are also conditions that can directly lead to pulmonary edema.

In addition, there are many other factors that increase the risk of developing the disease:

2.1.1. Translation overload

Too much fluid in the body. Especially in patients with cardiovascular disease, unstable kidney function is a condition that makes pulmonary edema easy, if not a common factor leading to the disease.

2.1.2. Narrow heart valves

Narrowing of certain heart valves causes fluid to pool, preventing blood from being pumped out of the heart. Stagnant blood in the heart will also "bounce" back to the lungs. Therefore, acute pulmonary edema may occur. Prominent in the mitral stenosis pathological stenosis , the most common cause is age-related degeneration or rheumatic heart disease.

2.1.3. Cardiomyopathy

This situation causes a decrease in myocardial contractility and results in severe fluid retention in the lungs:

Myocardial ischemia and myocardial infarction are the most obvious causes. Also known as coronary artery disease. Patients, especially the elderly, with a history of hypertension, or chest pain, dyslipidemia, and diabetes, are at very high risk of coronary artery disease.

2.1.4. Other cardiovascular disease

A number of other cardiovascular diseases also affect the heart's ability to contract and function smoothly and push it to pulmonary edema, such as:

• Endocarditis.
• Dissecting aortic aneurysm .
• Complications related to prosthetic heart valves.
• Injury.
• Severe hypertension.
• Tumors such as mucinous tumors in the heart.

2.2. Damaged pulmonary edema

These are cases due to lung damage that causes fluid that is inherently outside to "spill" into the Lungs. Most commonly described is due to acute respiratory distress syndrome  (ARDS). Causes of this condition include:

• Sepsis.
• Severe pneumonia caused by bacteria, viruses, ...
• Extrathoracic trauma.
• Poisoning or inhaling poison.
• Water asphyxia.
• Disseminated intravascular coagulation…

In general, there are many causes of pulmonary edema. The common feature is that it causes lung damage and increases the permeability of the membrane between the lungs and the pulmonary blood vessels (called the capillary alveolar membrane). Patients also develop symptoms that are more similar to cardiogenic pulmonary edema.

3. Symptoms of pulmonary edema

• Dyspnea: Often prominently the patient has severe shortness of breath. You have to sit up to breathe, breathe quickly, and pull the muscles in the neck and chest area.
• Pale or cyanotic: due to severe hypoxia.
• Coughing up pink foam: Very important and can be a sign that can help identify the disease. However, this is a pretty good sign and even indicates the severity of the disease.
• Agitation: The patient may struggle, get excited, even yell. Can be described as “calling for help when drowning on land”
• Symptoms of the accompanying underlying disease: Chest pain, high fever, edema, skin lesions ...
• Manifestations of hypertension are seen in cases of hemodynamic pulmonary edema. Blood pressure can be very high, systolic pressure can be over 200 mmHg.

Shortness of breath is the most important and prominent sign.

4. What should be done when the patient has acute pulmonary edema?

In a patient with the above risk factors, dyspnea was prominent. Caregivers should note and handle the following steps:

• Immediately contact emergency and urgently bring the patient to the nearest medical facility.
• This is the most important operation to save the patient's life. Only when severe hypoxia is improved can the patient recover.
• Reassure the patient.
• Instruct the patient to take a deep breath, breathe evenly, and stay as calm as possible. The state of panic agitation causes the patient to increase the work of breathing. It takes more effort to breathe and can make hypoxia worse due to exhaustion of the respiratory muscles. Therefore, family members should try to stay calm and help reduce panic of the patient, this will have many positive advantages.
• Move and give first aid to the patient according to instructions.
• Let the patient sit and breathe and limit excess manipulation and handling. Do not follow instructions from non-medical personnel. It is paramount to limit self-treatment time and get the patient safely to the doctor as quickly as possible.

5. Treatment methods

The emergency treatment and saving the patient's life necessarily need the role of the doctor. Doctors will deal with this situation by the main principles:

• Support the patient to breathe oxygen.
• Correction of fluid overload with diuretics or vasodilators
• Blood pressure stable.
• Control the underlying disease causing pulmonary edema. For example, in the case of pulmonary edema due to kidney failure, the patient may need emergency hemodialysis treatment.

However, acute pulmonary edema is a consequence of the disease. In order to treat stably and prevent the recurrence of acute pulmonary edema, it is necessary to well correct the underlying disease. The most common and important as mentioned is still cardiovascular disease. Diseases of heart failure, coronary artery, heart valve, hypertension need special attention and prevent recurrence of acute pulmonary edema.

Early delivery of oxygen is vital to saving the patient's life.

6. What should be done to prevent the day situation from happening.

With that said, it is important to recognize and prevent episodes of pulmonary edema. This is completely feasible and has a prerequisite value in saving the patient's life. Included through the following forms:

• Actively treat underlying diseases such as hypertension, diabetes, kidney failure.
• Do not arbitrarily quit taking medication without consulting a specialist.
• Exercise reasonably and regularly. Maintain a healthy weight.
• Eat and drink with all the groups of substances and in accordance with the characteristics of that individual's disease. Limit starch and sweets in diabetic patients, limit salt in heart and body disease patients. It is necessary to consult a specialist in these cases.
• Stop smoking, reduce alcohol and drugs.
• Manage stress, reduce stress to have
• Regularly monitor blood pressure.
• Identify the early signs of pulmonary edema mentioned above in situations to prepare for an effective response to the disease.

Acute pulmonary edema is a serious medical condition that is a complication of many different diseases. Prominent among the causes are problems of cardiovascular disease and nephropathy. Therefore, it is necessary to well control these underlying conditions to minimize the risk of pulmonary edema. In the event that an attack of pulmonary edema has occurred, the most important thing is to quickly bring the patient to the nearest medical facility so that they can receive emergency treatment and timely treatment. The safe transport time should be as short as possible, which will directly affect the ability to save and the patient's life.

Doctor Dinh Gia Khanh