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Noncardiogenic Pulmonary Edema Alan Cheng AM Report 5/12/09
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Starling Principle Net Filtration = C x (Pcap – Pint) – (Ocap – Oint) Rate of lymphatic reabsorption
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Permeability Problems ARDS Bilateral infiltrates, hypoxia (P:F ratio), Wedge <= 18 Sepsis Aspiration Pneumonia Trauma or burns TRALI – within 6 hours of completion of transfusion Relief of upper airway obstruction Lung/bone marrow transplant Drugs/meds/alcohol
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Hydrostatic pressure problems often due to cardiogenic pulmonary edema...) PCWP > 18 Volume overload – renal failure Not hepatic failure or nephrotic syndrome
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Oncotic pressure problems Hypoalbuminemia and nephrotic syndrome rarely cause nephrotic syndrome Lung capillaries normally are more permeable, and therefore interstitial oncotic pressure is ~ 18, and body maintains this. Thus, drop in capillary oncotic pressure does not affect lungs, but does affect periphery. Increased lymphatics in lungs Nephrotic syndrome will cause pulmonary edema when combined another insult, eg increased L atrial pressures.
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Other causes of noncardiogenic pulmonary edema: High altitude pulmonary edema Neurogenic pulmonary edema Reperfusion pulmonary edema Reexpansion pulmonary edema Opiate overdose Salicylate toxicity Pulmonary embolism Viral infections
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www.med.yale.edu/intmed/cardio/imaging/findin gs/pulmonary_edema/index.html Imaging
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www.med.yale.edu/intmed/cardio/imaging/findin gs/pulmonary_edema/index.html Imaging
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Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Texas Heart Inst J, 2001;28(1):53-6. Imaging Mitral regurg Right upper lobe
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References www.med.yale.edu/intmed/cardio/imaging/findings/pulm onary_edema/index.html Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Tex Heart Inst J. 2001;28(1):53-6. UpToDate Cecil’s Essentials of Medicine, 6 th ed, 2004
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