PULMONARY EDEMA. Slids realted to anesthesia and co exaiting doeases

Pulmanory edema slidss related to anesthezia diseasea

1. PULMONARY EDEMA

2. DEFINITION Pulmonary edema is the abnormal accumulation of fluid in the interstitial spaces surrounding the alveoli with the advancement of fluid accumulation in the alveolar spaces.

3. Pathophysiology 1 imbalance of starling force increase pulmonary capillary pressure decrease plasma oncotic pressure increase negative interstitial pressure 2 damage to alveolar- capillary barrier 3 lymphatic obstruction 4 Disruption of endothelial barrier allow protein to escape capillary bed and enhance movement of fluid in to the tissue of the lung 5 idiopathic or unknown

4. Classification based on inciting mechanism 1. Imbalance of Starling force A. Increased pulmonary capillary pressure left ventricular failure Volume overload B. Decreased plasma oncotic pressure Hypoalbuminemia due to different cause C. Increased negativity of interstitial pressure Rapid removal of pneumothorax with large applied negative pressures (unilateral)

5. Causes

6. Causes 3. Lymphatic insufficiency After lung transplant Lymphangitic carcinomatosis Fibrosing lymphangitis 4. Unknown or incompletely understood High-altitude pulmonary edema Neurogenic pulmonary edema Narcotic overdose Pulmonary embolism Eclampsia After anesthesia After cardiopulmonary bypass

7. Risk factors MI OR preexisting myocardial disease ,pump failure Drugs /toxins ,drugs reaction ,myocardial depression Fluid overload ,renal failure ,old age Aspiration Pre-existing lung disease or infection Malnutrition Acute head injury Airway obstruction Severe hypertension Lateral position

8. Classification

9. Symptom(AWAKE PATIENT) ACUTE Shortness of breath A Feeling of suffocating Anxiety ,restlessness Cough-frothy sputum that may be tinged with blood excessive sweating pale skin chest pain if PE is cause by cardiac abnormality palpitation

10. Symptom(AWAKE PATIENT) Long term(chronic) Paraxosomal nocturnal dyspnea orthopnea Rapid weight gain Loss of appetite fatigue ankle and leg swelling

11. Sign Tachycardia Tachypnea Confusion Agitation Anxious Diaphoric Hypertension Cool extremities Rales Wheezing CVS findings ; S3 jugular venous distention ….. Evidence of MI

12. Differential diagnosis Pneumothorax Bronchitis Cardiac tamponed COPD Pericarditis Pneumonia (bacterial , viral) Pulmonary embolism Shocks (cardiogenic ,septic ,anaphylactic) Venous air embolism

13. INVESTIGATION Imaging C hest radiography Echocardiography Ultrasound

14. DIAGNOSTIC FINDINGS Pulse oximetry <85% ABG: PaO2 = 30-50mm of Hg Chest X-ray shows areas of “white out ”( fluid filled area

15. Presentation The first signs of pulmonary edema in an anesthetized patient are often hypoxemia and decreased SpO 2 . Rales or wheezing are heard over the lung fields . Frothy sputum may be noted in the endotracheal tube . In an awake patient, respiratory distress, tachycardia and agitation. Jugular venous distension may be seen on physical examination .

16. Prevention • Avoid fluid overload in a patient with compromised myocardial function . • Ensure adequate perfusion pressure and avoid tachycardia in patients with coronary artery disease. Identify patients at risk for airway obstruction. Special Considerations Negative pressure pulmonary edema often resolves within 24 hours. Cardiogenic pulmonary edema may occur 2–3 days postoperatively when fluids are mobilized

17. Immediate Management • Increase FIO 2 to 100%. • Initiate diuresis (start with furosemide 20 mg IV). • Intubate the trachea and begin positive pressure ventilation with PEEP (5-10 cmH 2 o) if the patient is hypoxic or respiratory failure is imminent. • If cardiogenic pulmonary edema is suspected, consider afterload reduction with nitroglycerine (Infusion starting at 0.5 mcg/kg/min ) and support blood pressure with vasopressors Treat the underlying cause

18. MANAGEMENT Correction of hypoxemia O2 therapy Mechanical ventilation Reducing preload Upright position Diuretics Vasodilators Reducing after load Antihypertensive agents Supporting perfusion Ionotropic medications