Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask

Article Abstract:

Heart attacks and heart failure may result in pulmonary edema, the accumulation of fluid in the tissues of the lungs. This condition is a common cause of respiratory failure in hospitalized patients and often necessitates inserting an endotracheal tube and providing the patient with mechanical respiratory support. Intubation and mechanical ventilation improve the respiration of the patient, but may themselves result in further complications. A study was conducted to determine if oxygen with continuous positive airway pressure could provide benefits to patients with pulmonary edema without requiring intubation. In continuous positive airway pressure, the patient wears a tight-fitting mask. As the name implies, the pressure of the oxygen and air mixture within the mask is greater than that of the surrounding air. It requires less effort, therefore, to draw oxygen into the lungs. Thirty-nine patients were randomly assigned to receive oxygen or oxygen with continuous positive airway pressure. All patients were suffering from pulmonary edema as a complication of heart disease. Patients receiving oxygen with continuous positive airway pressure experienced a greater decrease in respiration rate in the first 30 minutes and a greater decrease in arterial carbon dioxide, indicators of more effective breathing. Seven of the patients receiving only oxygen required intubation with mechanical ventilation. In contrast, intubation was not required for any of the patients receiving oxygen plus continuous positive airway pressure. Four of 20 patients receiving oxygen died, as did 2 of the 19 patients receiving oxygen with continuous positive airway pressure. This difference in mortality, however, was not statistically significant. It is not yet known whether the early physiological advantages of oxygen and continuous positive airway pressure will result in long-term patient gains. However, the method appears safe and effective, and reduces the need for intubation and mechanical ventilation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Heart diseases

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High-altitude pulmonary edema

Article Abstract:

High-altitude edema in mountain climbers may be due to stress failure, the disruption of capillary junctions at the base of the lungs. The increased pressure on lung arteries causes stress failure rather than ruptured capillaries. A 1996 study showed for the first time that inhaled nitric oxide among mountaineers with high-altitude edema dilated the blood vessels in the lungs, especially in those regions not saturated by fluids. Some physiological aspects of the edematous lungs remain unexplained, prompting further inquiry. Administrating inhaled nitric oxide causes few side effects but is less convenient than oral nifedipine. Access to inhaled oxygen is therapeutically equivalent to nitric oxide. The therapeutic value of nitric oxide may extend to other conditions, such as pulmonary edema at sea level.

Health aspects, Physiological aspects, Lungs, Dosage and administration, Nitric oxide, Vasodilators, Vasodilator agents, Pulmonary circulation

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Predicting cerebral edema during diabetic ketoacidosis

Article Abstract:

Cerebral edema may occur in diabetics who have a severe episode of diabetic acidosis. Cerebral edema occurs when water collects in the brain and the brain swells.

Causes of, Cerebral edema, Complications, Diabetic acidosis, Ketoacidosis, Diabetic ketoacidosis

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