Pulmonary edema: causes, symptoms, emergency care. Pulmonary edema: oxygen therapy is a mandatory method of treatment See also in other dictionaries

Pulmonary edema is a physiological condition of a person in which plasma from the pulmonary vessels penetrates the interstitium and alveoli, which significantly affects the quality of gas exchange between the lungs and the inhaled air, and this, in turn, leads to acute oxygen starvation of all organs of the body.

Pulmonary edema is of two types, and is divided among themselves by the pathogen:

Diagnostics

To correctly diagnose the causes of pulmonary edema, the doctor should definitely and very carefully interview the patient if he is conscious. If the patient is not conscious or cannot answer questions, then a comprehensive examination is required, during which it will be possible to suggest possible causes of edema.

Laboratory tests may also be used to make a diagnosis, including:

	A blood test that confirms or refutes the presence of infection in the body due to an increased number of platelets.
	Blood biochemistry will determine the presence of heart disease that can cause edema.
	A coagulogram with an increased amount of prothrombin will confirm swelling of the lungs due to pulmonary thromboembolism.
	Study of the gas composition of the lungs.

The patient may also be asked to undergo additional examinations to determine in more detail the cause of edema; these examinations are selected at the discretion of the doctor.

Symptoms of pulmonary edema

Symptoms of edema appear and develop very quickly. Symptoms strongly depend on the rate of penetration of plasma from the interstitium into the alveoli.

Based on the rate of plasma penetration, four different types of edema are determined:

	Spicy- in this form, the first symptoms of alveolar edema appear within 2-4 hours after the appearance of the very first symptoms of interstitial edema. The causes may be myocardial infarction and stress.
	Subacute- the duration of this edema ranges from 4 to 12 hours, usually develops due to the presence of renal or liver failure, or congenital disorders in the functioning of blood vessels.
	Protracted is swelling that lasts about 24 hours. This form of the disease appears in the presence of chronic diseases of the liver, kidneys, and lungs.
	Fulminant- such swelling is observed only after anaphylactic shock or extensive myocardial infarction and leads to rapid death.

The main symptoms include:

	Loud breathing, even in a state of physical rest, shortness of breath is observed.		A sudden feeling of acute lack of air, which intensifies in a supine position.
	Feelings of squeezing or pressing pain in the chest.		Rapid and intense heartbeat.
	Sputum production with pinkish foam when coughing.		Pale or bluish skin.
	Coma.

Basic treatment methods

Pulmonary edema is an acute condition of the body that can be fatal to a person, therefore, if any of its manifestations occur, you should immediately call for medical help. During transportation to the hospital, the patient is placed in a semi-sitting position, oxygen inhalation is performed or, in case of severe shortness of breath, an artificial respiration apparatus is installed.

Subsequent treatment is carried out in the intensive care unit or intensive care unit, where the patient is under constant supervision.

Use of oxygen concentrators

For all types of pulmonary edema it is used oxygen therapy by using oxygen concentrators. Oxygen therapy has a positive effect on all organs and cells of the human body, and especially on the heart. Taking oxygen inhalation can reduce the permeability of the pulmonary membranes, which holds plasma in the vessels and does not allow them to penetrate to the alveoli.

With alveolar edema, the entire respiratory cavity is filled with pinkish foam, which prevents oxygen from entering the lungs; for this purpose, special drugs are used - defoamers, which can not only help a person receive a life-saving dose of oxygen, but also protect against asphyxia.
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Pulmonary edema is a pathological condition that is caused by the sweating of non-inflammatory fluid from the pulmonary capillaries into the interstitium of the lungs and alveoli, leading to a sharp disruption of gas exchange in the lungs and the development of oxygen starvation of organs and tissues - hypoxia. Clinically, this condition is manifested by a sudden feeling of lack of air (suffocation) and cyanosis (cyanosis) of the skin. Depending on the causes that caused it, pulmonary edema is divided into 2 types:

membranous (develops when the body is exposed to exogenous or endogenous toxins that violate the integrity of the vascular wall and alveolar wall, resulting in fluid from the capillaries entering the lungs);
hydrostatic (develops against the background of diseases that cause an increase in hydrostatic pressure inside the vessels, which leads to the release of blood plasma from the vessels into the interstitial space of the lungs, and then into the alveoli).

Causes and mechanisms of development of pulmonary edema

Pulmonary edema is characterized by the presence of non-inflammatory fluid in the alveoli. This disrupts gas exchange, leading to hypoxia of organs and tissues.

Pulmonary edema is not an independent disease, but a condition that is a complication of other pathological processes in the body.

Pulmonary edema can be caused by:

diseases accompanied by the release of endogenous or exogenous toxins (infection entering the bloodstream (sepsis), pneumonia (pneumonia), drug overdose (Fentanyl, Apressin), radiation damage to the lungs, taking drugs - heroin, cocaine; toxins violate the integrity of the alveolar capillary membrane, as a result, its permeability increases, and fluid from the capillaries exits into the extravascular space;
heart disease in the stage of decompensation, accompanied by left ventricular failure and stagnation of blood in the pulmonary circulation (heart defects);
pulmonary diseases leading to stagnation in the right circulation (bronchial asthma, emphysema);
pulmonary embolism (in persons predisposed to thrombus formation (suffering from hypertension, etc.), a blood clot may form, followed by its separation from the vascular wall and migration with the bloodstream throughout the body; reaching the branches of the pulmonary artery, the thrombus can clog its lumen, which will cause an increase in pressure in this vessel and the capillaries branching from it - hydrostatic pressure increases in them, which leads to pulmonary edema);
diseases accompanied by a decrease in protein content in the blood (liver cirrhosis, kidney pathology with nephrotic syndrome, etc.); in the above conditions, the oncotic pressure of the blood decreases, which can cause pulmonary edema;
intravenous infusions (infusions) of large volumes of solutions without subsequent forced diuresis lead to an increase in hydrostatic blood pressure and the development of pulmonary edema.

Signs of pulmonary edema

Symptoms appear suddenly and increase rapidly. The clinical picture of the disease depends on how quickly the interstitial stage of edema transforms into the alveolar stage.

Based on the rate of progression of symptoms, the following forms of pulmonary edema are distinguished:

acute (signs of alveolar edema appear 2–4 hours after the appearance of signs of interstitial edema) – occurs with mitral valve defects (usually after psycho-emotional stress or excessive physical exertion), myocardial infarction;
subacute (lasts from 4 to 12 hours) – develops due to fluid retention in the body, with acute hepatic or congenital heart defects and great vessels, lesions of the lung parenchyma of a toxic or infectious nature;
prolonged (lasting 24 hours or more) - occurs in chronic renal failure, chronic inflammatory lung diseases, systemic connective tissue diseases (vasculitis);
fulminant (a few minutes after the onset of edema leads to death) - observed in anaphylactic shock, extensive myocardial infarction.

In chronic diseases, pulmonary edema usually begins at night, which is associated with the patient being in a horizontal position for a long time. In the case of pulmonary embolism, the development of events at night is not at all necessary - the patient’s condition can worsen at any time of the day.

The main signs of pulmonary edema are:

intense shortness of breath at rest; breathing is frequent, shallow, bubbling, it can be heard from a distance;
a sudden feeling of a sharp lack of air (attacks of painful suffocation), intensifying when the patient lies on his back; such a patient takes the so-called forced position - orthopnea - sitting with the torso bent forward and supported by outstretched arms;
pressing, squeezing pain in the chest caused by lack of oxygen;
severe tachycardia (rapid heartbeat);
cough with distant wheezing (audible at a distance), discharge of pink foamy sputum;
pallor or blue discoloration (cyanosis) of the skin, profuse sticky sweat - the result of centralization of blood circulation in order to provide oxygen to vital organs;
agitation of the patient, fear of death, confusion or complete loss of consciousness - coma.

Diagnosis of pulmonary edema

A chest x-ray will help confirm the diagnosis.

If the patient is conscious, the doctor’s primary concern is his complaints and medical history - he conducts a detailed questioning of the patient in order to establish the possible cause of pulmonary edema. In the case where the patient is not available for contact, a thorough objective examination of the patient comes to the fore, allowing one to suspect edema and suggest the reasons that could lead to this condition.

When examining a patient, the doctor’s attention will be drawn to pallor or cyanosis of the skin, swollen, pulsating veins of the neck (jugular veins) as a result of stagnation of blood in the pulmonary circulation, rapid or shallow breathing of the patient.

Cold sticky sweat may be noted by palpation, as well as an increase in the patient’s pulse rate and its pathological characteristics - it is weakly filled, thread-like.

When percussing (tapping) the chest, a dullness of the percussion sound over the lung area will be noted (confirms that the lung tissue has an increased density).

Auscultation (listening to the lungs using a phonendoscope) reveals hard breathing and a mass of moist, large-bubble rales, first in the basal, then in all other parts of the lungs.

Blood pressure is often elevated.

Of the laboratory research methods for diagnosing pulmonary edema, the following are important:

a general blood test will confirm the presence of an infectious process in the body (characterized by leukocytosis (an increase in the number of leukocytes), with a bacterial infection an increase in the level of band neutrophils, or rods, an increase in ESR).
biochemical blood test - allows you to differentiate “cardiac” causes of pulmonary edema from causes caused by hypoproteinemia (decreased protein levels in the blood). If the cause of edema is myocardial infarction, the level of troponins and creatine phosphokinase (CPK) will be increased. A decrease in the level of total protein and albumin in the blood in particular is a sign that the edema is caused by a disease accompanied by hypoproteinemia. An increase in urea and creatinine levels indicates the renal nature of pulmonary edema.
coagulogram (blood's ability to clot) - will confirm pulmonary edema resulting from pulmonary embolism; diagnostic criterion is an increase in the level of fibrinogen and prothrombin in the blood.
determination of blood gas composition.

The patient may be prescribed the following instrumental examination methods:

pulse oximetry (determines the degree of oxygen saturation in the blood) - in case of pulmonary edema, its percentage will be reduced to 90% or less;
determination of central venous pressure (CVP) values is carried out using a special device - a Waldman phlebotonometer connected to the subclavian vein; with pulmonary edema, CVP is increased;
electrocardiography (ECG) – determines cardiac pathology (signs of ischemia of the heart muscle, its necrosis, arrhythmia, thickening of the walls of the heart chambers);
echocardiography (ultrasound of the heart) - to clarify the nature of the changes detected on the ECG or auscultation; thickening of the walls of the heart chambers, decreased ejection fraction, valve pathology, etc. can be determined;
X-ray of the chest organs - confirms or refutes the presence of fluid in the lungs (darkening of the lung fields on one or both sides); in case of cardiac pathology - an increase in the size of the heart shadow.

Treatment of pulmonary edema

Pulmonary edema is a life-threatening condition for the patient, so at the first symptoms you must immediately call an ambulance.

During transportation to the hospital, emergency medical personnel carry out the following treatment measures:

the patient is placed in a semi-sitting position;
oxygen therapy with an oxygen mask or, if necessary, tracheal intubation and artificial ventilation;
nitroglycerin tablet sublingually (under the tongue);
intravenous administration of narcotic analgesics (morphine) - for the purpose of pain relief;
diuretics (Lasix) intravenously;
to reduce blood flow to the right side of the heart and prevent an increase in pressure in the pulmonary circulation, venous tourniquets are applied to the upper third of the patient’s thighs (preventing the disappearance of the pulse) for up to 20 minutes; remove the tourniquets, gradually loosening them.

Further treatment measures are carried out by specialists from the intensive care unit, where strict continuous monitoring of hemodynamic parameters (pulse and pressure) and breathing is carried out. Medicines are usually administered through the subclavian vein, into which a catheter is inserted.

For pulmonary edema, the following groups of drugs can be used:

to extinguish foam that forms in the lungs - so-called defoamers (oxygen inhalation + ethyl alcohol);
with high blood pressure and signs of myocardial ischemia - nitrates, in particular nitroglycerin;
to remove excess fluid from the body - diuretics, or diuretics (Lasix);
for low blood pressure - drugs that increase heart contractions (Dopamine or Dobutamine);
for pain - narcotic analgesics (morphine);
for signs of pulmonary embolism - drugs that prevent excessive blood clotting, or anticoagulants (Heparin, Fraxiparin);
for slow heart contractions - Atropine;
for signs of bronchospasm - steroid hormones (Prednisolone);
for infections - broad-spectrum antibacterial drugs (carbopenems, fluoroquinolones);
for hypoproteinemia - infusion of fresh frozen plasma.

Prevention of pulmonary edema

A patient with pulmonary edema is hospitalized in the intensive care unit.

Timely diagnosis and adequate treatment of diseases that can provoke it will help prevent the development of pulmonary edema.

Pulmonary edema is a dangerous phenomenon that is characterized by suffocation, severe shortness of breath, and the release of foamy fluid that clogs the airways and causes hypoxia. In case of pulmonary edema, it is necessary to pump out the foam and use inhalation with an antifoam agent. It is important to provide timely medical care, as this condition is dangerous and requires treatment in the intensive care unit.

The role of antifoaming agents in edema

With the pathology under consideration, up to 200 ml of plasma passes and accumulates in the small bronchi and pulmonary alveoli. The air that passes through the accumulated liquid tends to foam under such conditions. This process completely blocks breathing and requires urgent action, as it leads to inevitable death. Before arriving at the hospital, the ambulance team can provide the following actions: oxygen therapy, defoaming procedure, diuretic therapy.

The most effective means of medical care in such a situation is an antifoam, the property of which is to increase the surface tension of the plasma and quickly eliminate foaming.

Popular drugs and their uses

The type of drugs used to eliminate pulmonary edema depends on the cause of the disease.

The reasons are as follows:

Left ventricular failure causes cardiogenic edema.
In coma, with brain injury and brain diseases, non-irogenic edema may occur.
Poisoning by toxic substances when inhaled into the lungs, infection, anaphylactic shock can cause toxic edema.
Circulatory disorders, entry of a foreign body into the respiratory tract, swelling of the larynx and other causes of failure in the breathing process can cause pathogenesis and pulmonary edema in progressive forms.

Therapy to eliminate pulmonary edema can be started by taking a Nitroglycerin tablet (sublingually). As a rule, ethyl alcohol acts as a universal defoaming agent. To do this, use inhalation with air moistened with ethanol (ethyl alcohol). At the beginning, oxygen is introduced at a rate of three liters per minute, and then ten liters per minute, the whole process takes forty minutes. Antifomsilan is also an effective remedy, the effect of which occurs in three to five minutes.

Reducing the volume of circulating blood reduces swelling. For this procedure, fast-acting diuretics are used, for example, Furosemide. This diuretic drug is administered intravenously or orally, in the first case the diuretic effect occurs within a few minutes, and in the second - within an hour. Atacric acid is also an effective diuretic for pulmonary edema.

Cardiac glycosides provide a therapeutic effect in cardiogenic edema. This medicine improves venous outflow from the lungs and enhances the functioning of the heart. The drug is administered intravenously through a drip. Examples of cardiac glycosides include prenisolone and narcotic analgesics. Antihypertensive drugs and adrenomimetic are used with caution in cases of blood pressure disorders (normotension and hypotension). In addition, opiates are used to relieve pulmonary edema; they help reduce overexcitation, eliminate shortness of breath, and dilate blood vessels in the heart and lungs.

Morphine

For pulmonary edema, as a rule, one to two milliliters or one milliliter of a one percent morphine solution is injected subcutaneously or intravenously. This drug reduces depression of the respiratory center, reduces circulating blood volume and total peripheral resistance. It is worth considering that this remedy is contraindicated for low blood pressure. As a rule, to prevent the vagotromic effect of morphine, it is combined with a solution of atropine, which, moreover, has an antispasmodic effect.

Side effects: nausea, vomiting; depression of the respiratory center; gastrointestinal paresis.

To eliminate the negative effects of the drug, ganglion blockers are used.

Furosemide

For pulmonary edema (oral or parenteral), furosemide is used. Its effect is due to inhibition of the reabsorption of nitrogen, chlorine and potassium ions, most pronounced in the first few days. When administered intravenously, it lasts up to three hours, and when taken orally, it lasts for more than four hours. In addition, the drug has an antihypertensive effect. As a rule, it is combined with other antihypertensive drugs. Furosemide is taken before meals, the dose depends on the severity of the pathology. Sometimes, oral use causes difficulty in absorption from the intestine, loss of consciousness, so the medicine is administered intramuscularly or intravenously.

Side effects: skin hyperemia; nausea, itching; stomach upset; hearing impairment; dizziness; muscle weakness; depression; thirst.

The manifestation of a negative effect of the drug makes it necessary to reduce the dose used.

Furosemide is contraindicated in:

pregnancy;
renal failure;
hepatic coma.

In addition, the drug cannot be combined with drugs that have nephrotoxic effects.

Eufillin

Euffilin is a medicine that can be used for pulmonary edema. The drug is available in ampoules for injection and in tablet form. The tablet is taken two to three times a day after meals.

The drug is contraindicated in case of low blood pressure, sclerosis of the heart vessels, tachycardia, extrasystole, during myocardial infarction. Children under 14 years of age should take euffilin with caution.

Side effects: abdominal pain, nausea and vomiting, gastrointestinal upset, headaches, insomnia, increased excitability.

Dexamethasone

Dexamethasone is a drug that is used during pulmonary edema to provide anti-inflammatory and immunosuppressive effects. The dosage is determined individually.

Side effects: increased appetite, weight gain, transient adrenal insufficiency. Less commonly, increased levels of triglycerides in the blood and acute inflammation of the pancreas may occur.

Attention! At the first manifestations of pulmonary edema, call an ambulance, since only doctors will be able to provide first aid to the patient and take him to the hospital in a timely manner.

The lungs are an organ that takes part in supplying oxygen to the body and removing waste products of metabolism, in particular carbon dioxide. The main structural unit in this case is the pulmonary alveolus (vesicle), consisting of a semi-permeable membrane and surrounded by tiny blood vessels - capillaries. When air enters the bronchi and alveoli during inhalation, oxygen molecules overcome the membrane and end up in the blood, where they bind to red blood cells. Oxygen is then transported to all cells in the body. During exhalation, carbon dioxide from red blood cells penetrates into the lumen of the alveoli and is removed with the exhaled air.

If respiratory function is impaired, all internal organs, and primarily the brain, suffer from oxygen deficiency and excess carbon dioxide in the blood. With pulmonary edema, these disorders develop quite quickly, so it can cause brain hypoxia and clinical death.

Penetration of the liquid part of the blood into the lungs from the blood vessels occurs due to high pressure in the vessels of the lungs or due to direct damage to the pulmonary membrane. In the first case, the liquid sweats through the vascular wall, and in the second it penetrates the alveoli as a result of a violation of the anatomical barrier between the capillaries and the lung tissue.

More often, edema of the pulmonary tissue occurs in patients over 40 years of age due to the greater prevalence of cardiac pathology in this population, but it also develops in children and adults. The prevalence of this pathology increases sharply after 65 years.

Causes of the disease

Depending on the condition that led to pathophysiological disorders in the lungs, cardiogenic, or cardiac, and non-cardiogenic variants are distinguished.

Cardiac pulmonary edema(acute left ventricular failure), can complicate the course of diseases such as:

Acute myocardial infarction is the cause of pulmonary edema in 60% of cases.
Chronic heart failure - 9%.
Acutely occurring cardiac arrhythmia – in 6%.
Heart defects (acquired and congenital) - 3%.

Non-cardiogenic pulmonary edema occurs in 10% of all emergency conditions and is caused by any of the following reasons:

The development of non-cardiogenic pulmonary edema occurs through several mechanisms at once - a damaging effect on the capillary-alveolar membrane of toxic agents, an increase in blood volume with significant intravenous fluid intake, protein metabolism disorders in diseases of internal organs, dysfunction of the cardiovascular system, disturbances in the nervous regulation of external respiration function for diseases of the central nervous system.

Unfortunately, not only people, but also pets are susceptible to this condition. The most common causes of pulmonary edema in cats and dogs are distemper, inhalation of hot air, overheating of the body and heat stroke, pneumonia, and poisoning by toxic gases.

Symptoms of the disease

With a cardiogenic nature, an increase in symptoms is possible within a few days before the appearance of pronounced signs of pulmonary edema. The patient is bothered by episodes of cardiac asthma at night - shortness of breath (respiratory rate 30 per minute or more), obsessiveness and difficulty in inhaling. These are signs of interstitial edema, in which the liquid part of the blood accumulates in the lung tissue, but does not yet penetrate the alveoli.

The general condition is severe - severe weakness, cold sweat, severe pallor and coldness of the extremities are noted; with further development, the bluish color of the skin quickly increases - cyanosis. Blood pressure decreases, pulse is frequent and weak. The patient experiences severe fear and anxiety, and breathing is only possible in a sitting position with emphasis on the arms (orthopnea).

Another option for the development of edema is also possible, when, against the background of complete health, an already existing, asymptomatic heart disease debuts with the symptoms described above. For example, this option occurs when asymptomatic myocardial ischemia leads to the development of a heart attack with acute left ventricular failure.

Non-cardiogenic pulmonary edema is clinically manifested by similar signs that suddenly develop, for example, after inhaling a toxic substance, against the background of a high fever or during pneumonia.

In children the initial signs of pulmonary edema are sometimes difficult to suspect if it is caused by bronchitis or pneumonia, due to the fact that the symptoms of the underlying disease also include coughing, wheezing and increased breathing. In this case, parents should be alerted to such signs as sudden severe shortness of breath, sudden cyanosis of the skin of the face or limbs, bubbling breathing and the appearance of foamy sputum.

In some patients with cardiac pathology, left ventricular failure may develop several times, then it is called recurrent or chronic pulmonary edema. After successful relief of the previous edema in a hospital setting, after some time the patient again develops signs of cardiac asthma, which, in the absence of correction of the treatment, turns into alveolar pulmonary edema. This option is prognostically unfavorable.

Diagnosis of the disease

The diagnosis can be suspected even at the stage of examining the patient based on the following signs:

Typical complaints
General serious condition
Retraction of intercostal spaces during breathing,
Swelling of the neck veins,
Increased humidity, pallor and cyanosis of the skin.

Additional methods are used to confirm the diagnosis:

In the emergency department of a hospital, where a patient with pulmonary edema is delivered, an ECG and X-ray are sufficient, since it is important to transport the patient to the intensive care unit as quickly as possible, without wasting time on examination. As the patient recovers from a serious condition, other diagnostic methods are prescribed.

At the prehospital stage It is important to distinguish pulmonary edema from bronchial asthma. The main differences are reflected in the table:

Signs	Bronchial asthma	Pulmonary edema
Dyspnea	Exhalation lengthened	Inhalation lengthened
Breath	Wheezing wheezes	Wet wheezing
Sputum	Scanty, viscous, glassy	Abundant, pink, foamy character
Disease history	History: episodes of bronchial asthma, allergic diseases	History of cardiac disease
ECG signs	Right ventricular overload	Left ventricular overload

Treatment

Emergency assistance should be provided immediately as soon as others notice signs of swelling in the patient. The algorithm of actions boils down to the following activities:

Calm the patient, give him a semi-sitting position, lower his legs down,
Measure blood pressure and heart rate,
Call an ambulance, describing in detail to the dispatcher the dangerous symptoms,
Open the window for fresh air,
Reassure and explain to the patient that panic will worsen his condition,
If blood pressure is within normal limits (110-120/70-80 mmHg), take a nitroglycerin tablet under the tongue; if the pressure is lower, it is not recommended to take nitroglycerin.
Place the patient's legs in a basin of hot water to reduce venous return to the heart,
If signs of clinical death appear (lack of consciousness, breathing and pulse in the carotid artery), begin chest compressions and artificial respiration with a ratio of 15:2 until the medical team arrives.

The actions of the emergency doctor are as follows:

Taking and interpreting ECG,
Supply of humidified oxygen through a mask, passed through a 96% ethyl alcohol solution to reduce foaming,
Administration of diuretics intravenously (furosemide), nitroglycerin (if blood pressure is reduced, then in combination with drugs that maintain its level - dopamine, dobutamine),
The use of medications depending on the underlying disease - morphine or promedol for acute infarction, antiallergic drugs (diphenhydramine, pipolfen, suprastin, prednisolone) for the allergic nature of the disease, glycosides (strophanthin, korglykon) for atrial fibrillation and other rhythm disturbances,
Immediate transportation to a specialized hospital.

Inpatient treatment is carried out in the intensive care unit. To relieve pulmonary edema, intravenous infusions of nitroglycerin, diuretics, and detoxification therapy are prescribed for the toxic nature of the disease. For diseases of internal organs, appropriate treatment is indicated, for example, antibiotic therapy for purulent-septic processes, bronchitis, pneumonia, hemodialysis for renal failure, etc.

Prevention of pulmonary edema

Patients after cardiogenic pulmonary edema, the underlying disease that led to such a dangerous condition should be treated. To do this, you must constantly take medications as prescribed by your doctor, for example, ACE inhibitors (enalapril, lisinopril, Prestarium, etc.) and beta-blockers (propranolol, metoprolol, etc.). It has been reliably proven that these drugs significantly reduce the risk of complications and sudden death from heart disease. In addition to drug treatment, it is recommended to follow a diet with a reduction in salt content in food to 5 mg per day and with the volume of liquids consumed up to 2 liters per day.

If the disease is non-cardiogenic, preventing re-edema comes down to treating diseases of the internal organs, preventing infectious diseases, careful use of toxic drugs, timely detection and treatment of allergic conditions, and avoiding contact with toxic chemicals.

Forecast

The prognosis for untimely seeking medical help is unfavorable, since respiratory failure leads to death.

The prognosis for emergency care provided on time is favorable, but for recurrent pulmonary edema it is doubtful.

Video: pulmonary edema - when it occurs, diagnosis, clinic

Some diseases are accompanied by a decrease in oxygen levels in the blood. In such cases, oxygen therapy comes to the rescue. The procedure is carried out in various ways:

inhalation, during natural breathing or during artificial ventilation;
non-inhalation, absorption of an oxygen cocktail subcutaneously or through the intestines.

Oxygen therapy is a procedure for treating with oxygen

For the normal existence of living organisms, it is necessary that there be 21% oxygen in the atmosphere. A decrease in concentration will lead to big problems, even death. But pure oxygen is also dangerous. For oxygen therapy, mixtures with a high oxygen content (20-80%) are used.

The term "oxygen therapy" comes from the Latin words "oxygenium" (oxygen) and "therapy" (treatment). The goal is to deliver more oxygen to the body. Indications for oxygen therapy:

Indications for the use of oxygen therapy also include helping in the action of certain medications and enhancing the effect of treatment for cancer.

The first experiments with oxygen therapy were carried out in the eighteenth century to revive newborns born without breathing. The method was the most primitive - a face mask connected to an oxygen bag. Oxygen therapy was even used to combat helminths (worms) by introducing oxygen into the intestines through a tube.

The gas composition for oxygen therapy usually contains 50-60% (up to 80%) oxygen, but in some cases other ratios are used. Indication for the use of carbogen (95% oxygen and 5% carbon dioxide) is carbon monoxide poisoning. In case of pulmonary edema with the release of foamy liquid, the gas mixture is passed through an antifoam agent (50% ethyl alcohol solution).

The safest composition for oxygen therapy contains 40-60% oxygen. Pure oxygen can cause burns to the respiratory tract. It can also be toxic to humans, resulting in dry mouth, chest pain, seizures, and loss of consciousness.

Before administering oxygen to the patient, it must be humidified. There are three types of humidification:

Passing through water. The method is not very effective. Large gas bubbles do not have time to absorb enough water and its temperature drops slightly. Heating the humidifier and using a fine-mesh sprinkler will help correct the shortcomings.
"Artificial nose" Air is passed through corrugated foil on the patient's face. The foil heats up from breathing and condenses exhaled moisture, giving it away when you inhale.
An aerosol inhaler is the most reliable way. It creates a suspension of tiny droplets of water in a gas composition.

Inhalation methods of oxygen supply

Oxygen therapy can be carried out both in clinical and at home settings. At home, you can use concentrators, pillows or balloons. These methods are indicated for long-term oxygen therapy, but only a specialist can prescribe treatment and choose a method. Improper use of oxygen mixtures can be dangerous!

In clinical settings, the following types of delivery are available:

Using nasal catheters. To prevent the mucous membrane from drying out, the mixture is moistened by passing it through water. The patient is given the composition through a nasal catheter (cannula) under a pressure of 2-3 atmospheres. The equipment includes two pressure gauges indicating the pressure in the cylinder and at the outlet.
Through a special mask that should fit tightly to the face. The supplied mixture is also moistened.
Mechanical ventilation device. With this method, gas is supplied through an endotracheal tube.

There is an inhalation type of oxygen therapy

Algorithm for performing oxygen therapy through a nasal catheter (cannula):

check the patency of the airways and, if necessary, clear them;
open the package with the catheter and measure the distance from the tip of the nose to the patient’s earlobe;
lubricate the inserted end of the catheter with Vaseline;
lift the tip of the nose and insert the cannula along the lower nasal passage to the back wall of the pharynx (at a distance from the nose to the earlobe);
ask the patient to open his mouth to check the catheter - the inserted end of the tube should be visible in the pharynx;
connect the outer end of the catheter to a source of humidified gas and secure it with a bandage on the cheek, forehead or neck;
open the supply valve, supply rate is 2-3 liters per minute;
monitor the patient’s condition for 5 minutes;
change the position of the cannula every half hour or hour to prevent bedsores and drying out of the mucous membrane.

If an oxygen cushion is used for inhalation, then before use you need to make sure that it is filled with gas from a cylinder (the external pressure gauge should show 2-3 atm.) and a clamp is applied to the outlet tube. The nurse should disinfect the funnel attached to the pillow. Algorithm for using an oxygen cushion:

Hyperbaric oxygenation (from the Greek “heavy”) combines both delivery methods. This is a method of saturating the body with oxygen under high pressure. The method is used for therapeutic and prophylactic purposes. Sessions are conducted in a special pressure chamber with increased pressure and gas concentration. Indications include thermal burns, frostbite, decompression, skin grafting, high blood loss, gangrene.

Non-inhalation methods of oxygen therapy

The supply of oxygen bypassing the respiratory system is called non-inhalation oxygenation. These methods include:

Enteral (through the gastric tract). Once in the stomach, oxygen passes into the intestines and is absorbed into the bloodstream. This technology has previously been used to revive newborns or for respiratory failure in adults. Nowadays, the method of oxygenation using oxygen cocktails is widespread - patients receive gas mixtures whipped into foam or mousse. This therapy is used for toxicosis, chronic respiratory failure, obesity, and acute liver failure.
Intravascular. Blood or blood substitute transfused to a patient is pre-saturated with oxygen.
Cutaneous. This method is most often used for cardiovascular diseases, complications of injuries, wounds or ulcers. It consists of taking general or local oxygen baths.

Non-inhalation oxygen therapy is also used

In addition to those listed, non-inhalation types include subcutaneous, intra-articular, and intracavitary methods of oxygen therapy. Indications for their use are wounds, inflammatory processes, ulcers.

Features of oxygen therapy in children

Hypoxia in children develops very quickly. This is due to the fact that the mechanism for compensating for the lack of oxygen begins to develop only at 5-6 months of life and is fully formed by 7-8 years. Any problems with the respiratory or circulatory system, anemia, or metabolic disorders can lead to hypoxia. Only a pediatrician has the right to prescribe therapy; independent treatment is unacceptable!

For children, inhalation oxygen therapy is most often used. Oxygen tents or awnings and mouth masks are widely used. In some cases, it is inserted into the airways with a nasal catheter. Mouthpieces, funnels or nipples are not very convenient and are hardly used.

The optimal concentration for children is 40-60%. The mixture must be moistened to avoid drying out the mucous membrane. The duration of sessions is prescribed by the doctor based on the age and weight of the baby. For children born with asphyxia, oxygenation in a pressure chamber is increasingly used.

Oxygen treatment is indicated for children

Non-inhalation oxygenation techniques are practically not used for children. Sometimes oxygen is introduced into the intestines for enterobiasis, chronic colitis, urinary incontinence, and ascariasis.

The procedure causes anxiety in children, which can lead to disturbances in cardiac activity or breathing. To avoid complications, consultation with a specialist and compliance with the rules and technology of oxygenation are necessary.

Safety precautions

In high concentrations, oxygen is toxic. Up to 60% concentration it is harmless even with prolonged use. If pure oxygen is used for more than 24 hours, complications are possible: changes in the lungs, necrosis of nerve cells, and blindness in premature babies.

In the event of a leak, oxygen accumulates in the lower part of the room (it is heavier than air). Ethyl alcohol, any oil or organic fat forms an explosive cocktail with oxygen. One spark will be enough to cause a cylinder to explode or cause a fire if there is an oxygen leak.

Specially trained people must work with oxygen cylinders (change, connect) in compliance with safety regulations. Despite the apparent simplicity of the replacement algorithm, there is a great danger to life and health.