Pulmonary Edema Treatment
Pulmonary edema is the buildup of fluids within the lungs, which makes it difficult to breath. Pulmonary edema is most often caused by cardiac issues, with more than 1 million individuals being admitted to the hospital with a diagnosis of cardiogenic pulmonary edema each year. Causes of cardiogenic pulmonary edema include heart attack, narrowed or leaking heart valves and/or sudden and severe high blood pressure, among other cardiac issues. However, pulmonary edema can also be caused by non-cardiac issues as well, including pneumonia, kidney failure, chest wall trauma, exposure to certain medications and/or toxins, as well as high-altitude physical activity, among various other issues. In this article, we will discuss pulmonary edema treatment options.
Pulmonary edema is classified as:
- Acute pulmonary edema – develops suddenly and requires immediate medical attention. Acute pulmonary edema can cause death, but prognosis improves if treated quickly.
- Chronic pulmonary edema.
Symptoms of Pulmonary Edema
Symptoms of pulmonary edema may develop suddenly or overtime. The signs and symptoms of pulmonary edema differ, depending on the type and underlying cause.
Symptoms of acute pulmonary edema may include:
- Breathing difficulties (shortness of breath) especially when lying down or with physical activity.
- Coughing up blood or frothy sputum.
- Feeling like you are drowning or suffocating.
- Wheezing, gurgling and/or grunting sounds when breathing.
- Rapid heartbeat or heart palpitations.
- Anxiety and/or restlessness.
- Clammy and/or cold skin.
- Bluish tinged lips.
Symptoms of chronic pulmonary edema may include:
- Breathing difficulties when lying down or with physical activity.
- Waking up at night with a cough or shortness of breath that is relieved by sitting upright.
- Wheezing.
- Lower extremity swelling.
- Rapid weight gain.
- Fatigue.
- New or worsening cough.
Symptoms of high-altitude pulmonary edema tend to be worse at night and may include:
- Headache (often the first symptom).
- Shortness of breath (initially with physical activity but then progresses to shortness of breath at rest).
- Decreased exercise tolerance.
- Dry cough that eventually produces a frothy, blood-tinged sputum.
- Rapid heartbeat.
- Low-grade fever.
- Weakness.
- Chest pain.
Treatment for Pulmonary Edema
Treatment of pulmonary edema focuses on alleviating symptoms and treating the underlying issue causing the buildup of fluid.
The following four treatments are commonly used to treat pulmonary edema:
1. Supplementary Oxygen
This is the first line of treatment for acute pulmonary edema, when someone’s oxygen saturation level falls below 92%. Oxygen is delivered through a face mask or nasal cannula. In some cases, when non-invasive oxygen supplementation fails to improve breathing, or in those with signs of physical exhaustion, decreased consciousness, or cardiogenic shock, a mechanical ventilator may be needed.
2. Diuretics (Furosemide)
Diuretics are a mainstay of pulmonary edema treatment, as these drugs work to decrease the pressure caused by fluid buildup. Higher doses of diuretics have been shown to improve breathing issues but are associated with a transient worsening of kidney function.
3. Vasodilators
These may be added to diuretics for the treatment of pulmonary edema. Typically, IV nitroglycerin is the drug of choice, as it helps to lower pressure and pulmonary congestion. However, it should only be used when the systolic blood pressure is greater than 110 mmHG. New vasodilators, including serelaxin and clevidipine, may also be utilized, as they have been shown to improve breathing difficulties and decrease admissions to the ICU and the length of hospital stays.
4. Inotropes (Dobutamine and Dopamine)
These medications are given via IV and are used when there is pulmonary edema with associated low systolic blood pressure and signs of tissue/organ hypoperfusion. They help to improve heart function and maintain appropriate blood pressure. However, there are serious adverse events associated with these medications, including hypotension, ischemia and tachyarrhythmias.
It should be noted that while morphine has been part of the traditional treatment of pulmonary edema, the risks of this treatment, including respiratory depression requiring intubation, reduced cardiac output and hypotension, may outweigh the benefits in some cases, so it is generally not recommended.
Treating high-altitude pulmonary edema also involves supplemental oxygen in addition to the following:
- Descending to a lower altitude – descent 1,000 to 3,000 feet as quickly as possible if you are climbing or traveling at high altitudes and have any symptoms of pulmonary edema.
- Stop exercising.
- Stay warm.
- Take medication as needed – acetazolamide or nifedipine may be used to prevent or treat symptoms of high-altitude pulmonary edema.
In Review
Pulmonary edema is a serious medical condition that requires appropriate treatment. If you are experiencing any breathing difficulties that are concerning, it is important to speak to your doctor to get appropriate treatment as soon as possible. Additionally, seek immediate medical attention if you experience any acute pulmonary edema symptoms outlined above, as this is a medical emergency requiring urgent treatment for the best possible outcome.