Pulmonary edema in the elderly: symptoms, first aid, prevention

1. Causes of pulmonary edema
2. What diseases are there a risk of edema?
3. Types of pathology
4. Symptoms of pulmonary edema
5. Diagnostics
6. Treatment of pulmonary edema
7. Predictions and prevention

Pulmonary edema is a condition in which gas exchange is disrupted and respiratory failure develops. Swelling occurs due to an imbalance of pressure in the pulmonary capillaries and the release of a large amount of edematous fluid into the lung tissue without its reabsorption.

Causes of pulmonary edema

A mixture of edematous fluid (transudate) and a liquid substance that “lines” the alveoli of the lungs from the inside (it is called “pulmonary surfactant”) enters the lumen of the alveoli, where it combines with air. This leads to the formation of foam, which creates an obstacle to the flow of oxygen. Lack of oxygen provokes the development of shortness of breath, due to which the pressure inside the chest decreases and blood flow to the right side of the heart increases.

Pulmonary edema causes infiltration of the alveoli and is manifested by symptoms that indicate oxygen starvation, which is dangerous for tissues. The patient requires emergency care due to the high risk of death due to suffocation.

What diseases are there a risk of edema?

Pathology indicates a complication of the underlying disease, increases its duration and worsens the prognosis of treatment. The most dangerous from the point of view of pulmonary edema include:

• Heart diseases. Respiratory failure often occurs against the background of pathologies of the heart and blood vessels. Cardiogenic pulmonary edema is a life-threatening complication that develops with myocardial infarction, aneurysm, endocarditis and myocarditis, severe hypertension, and pathological conditions caused by congenital or acquired heart defects.
• Pulmonary diseases. At risk are patients with injuries and severe diseases of the respiratory tract. Respiratory edema develops against the background of exacerbation of chronic bronchitis and bronchial asthma, tuberculosis, and lobar pneumonia. The risk is increased by tumor lesions of the lung tissue, pleurisy, and chest injuries, which are accompanied by pneumothorax. If a person is connected to a ventilator for a long time and receives a mixture with a high concentration of oxygen, this also leads to an imbalance of pressure in the pulmonary capillaries and the release of exudate.
• Infectious diseases. In severe cases or inadequate treatment of whooping cough, scarlet fever, influenza, diphtheria and other infectious diseases, edema develops, followed by acute pulmonary failure. In young children, this clinical syndrome can cause acute laryngitis and the proliferation of adenoids.
• Pathologies of intrauterine development and difficult childbirth. Severe pregnancy, prematurity, oxygen hypoxia, fetal bronchopulmonary dysplasia - these factors increase the risk of developing pulmonary failure in newborns. In pregnant women, pulmonary failure can develop due to eclampsia. The same phenomenon occurs with ovarian hyperstimulation syndrome against the background of stimulation of ovulation by hormonal drugs.
• Foreign bodies entering the respiratory tract. Mechanical asphyxia is one of the possible causes of acute respiratory failure. Pathology occurs when foreign objects enter the respiratory tract, after drowning or attempted hanging, or blockage of the respiratory tract with vomit.
• Diseases of the urinary system and gastrointestinal tract. Nephrogenic pulmonary edema can be complicated by acute inflammatory diseases, which are accompanied by renal dysfunction and the development of severe renal failure. In gastroenterology, patients with liver cirrhosis, severe pancreatitis, and intestinal obstruction have to deal with respiratory failure.
• Neurological diseases. Traumatic brain injuries, meningitis, encephalitis, neoplasms, cerebral hemorrhages, complications after brain surgery - all this leads to neurogenic pulmonary edema.
• Allergies, injuries, poisoning. Acute respiratory failure can be caused by the ingestion of various toxic substances into the body. Pulmonary edema is encountered by patients with alcohol and drug intoxication, poisoning with drugs, salts of heavy metals, and toxic gases. Pulmonary insufficiency is diagnosed in case of blood poisoning, burns with a large affected area, acute allergic reactions.

Cardiogenic form

Cardiogenic OB occurs as a manifestation of left ventricular heart failure. The following diseases can lead to the development of pathology:

• myocardial infarction, post-infarction conditions;
• acquired heart defects (both aortic and mitral);
• hypertensive crisis;
• disturbances of heart rhythm and conduction (arrhythmias, blockades).

The mechanism of development of the cardiogenic form of edema is associated with an increase in pressure in the pulmonary capillaries. This occurs due to increased diastolic pressure in the left ventricle.

The left ventricle cannot contract enough to push all the blood out of the cavity into the aorta. This leads to an increase in pressure first in the left ventricle and then in the left atrium. Since the pulmonary veins flow into the left atrium, over time the pressure also increases in the pulmonary circulation. The fluid sweats first into the interstitial tissue and then into the alveoli.

By the same principle, the lungs swell due to hypervolemia (increased blood volume).

Hypervolemia can develop as a complication of infusion therapy.

Types of pathology

Depending on the cause of development, pulmonary edema can be cardiogenic or non-cardiogenic. In the first case, the cause of respiratory failure is cardiovascular disease. The second category includes all other pulmonary edema caused by diseases of the gastrointestinal tract, nervous system, and injuries.

Pulmonary edema is also classified according to the nature of its course. There are four types of pathology development:

• With fulminant development, severe respiratory failure occurs within a few minutes and leaves no chance of survival.
• Acute swelling can take up to four hours to develop. This form is considered less dangerous than the previous one, but in the absence of timely assistance, the risk of death is extremely high. Most often, acute pulmonary edema develops with myocardial infarction, traumatic brain injury, and acute allergic reactions.
• In case of intoxication, renal and liver failure, subacute pulmonary edema may occur. The intensity of symptoms is constantly changing, so continuous medical monitoring of the patient's condition is required.
• Prolonged swelling may take several days to develop. Symptoms are mild compared to the acute and subacute forms. Prolonged pulmonary edema usually occurs against the background of various chronic diseases, including heart failure.

Symptoms of pulmonary edema

Before the main symptoms of pulmonary failure appear, patients experience weakness and dizziness, a feeling of tightness in the chest, headache, and dry cough. A few hours after the first symptoms of the pathology, an attack of cardiac asthma develops - the first stage of pulmonary edema. It manifests itself:

• severe lack of air;
• severe dry cough;
• increased heart rate;
• hoarse breathing;
• profuse sweating;
• pale skin, blueness of nails and lips;
• feelings of fear and anxiety.

As a rule, the attack occurs at night or before dawn. In patients with cardiac diseases, cardiac asthma can be caused by physical or emotional stress and hypothermia.

As edema develops, the alveoli become involved in the pathological process. This leads to increased suffocation. The patient experiences severe shortness of breath, the face becomes burgundy-blue and puffy, the veins in the neck swell, and mental retardation appears. Breathing becomes hoarse, foam mixed with blood comes out of the mouth.

In the absence of medical care, the patient loses consciousness and falls into a coma. In this state, blood pressure decreases critically, breathing becomes shallow, and the pulse weakens. The cause of human death is asphyxia, in which the body experiences an acute lack of oxygen with an excess of carbon dioxide.

Health care

Emergency therapy includes the following procedures:

1. Using an oxygen mask (oxygenation). If the case is urgent, then the supply of oxygen through a mask is replaced by artificial ventilation.
2. The patient is given morphine as a pain reliever and sedative.
3. Aminophylline is also introduced, which helps remove excess sodium from the body, dilate the bronchi and improve blood circulation in the renal glands.
4. At the same time, doctors monitor the patient's blood pressure. If it exceeds the norm, then the patient is injected with sodium nitroprusside, and if the blood pressure is too low, then dobutamine is injected.

Further therapy includes taking medications. The doctor may prescribe:

• hormonal drugs;
• antibiotics;
• hepatoprotectors;
• antihistamines.

Diagnostics

A doctor can determine the development of pulmonary edema by numerous external symptoms. In addition, the patient is prescribed instrumental and laboratory examinations. Among them:

• measurement of blood oxygen levels, determination of carbon dioxide content;
• blood chemistry;
• electrocardiogram and ultrasound of the heart;
• chest x-ray to evaluate the condition of the lungs.

Inserting a catheter into the pulmonary artery allows you to determine the type of edema: cardiogenic or non-cardiogenic.

If pulmonary edema is suspected, it is important to carry out the necessary tests and examinations as soon as possible, identify the cause and type of pathology, and begin treatment. Saving the patient's life directly depends on this.

Treatment of pulmonary edema

People with acute respiratory failure are treated in the intensive care unit. First aid consists of measures that reduce venous return to the heart. To do this, the patient must take a semi-sitting position. Applying tourniquets to the limbs and hot foot baths have a positive effect.

It is imperative to monitor blood oxygen saturation levels. Oxygen therapy is used to compensate for its deficiency. If pulmonary edema has developed against the background of mechanical asphyxia, it is necessary to clear the airways of foreign objects. If it is impossible to breathe independently, the patient is connected to a ventilator.

A combination of medications is used to eliminate pulmonary edema. Among them:

• morphine and other narcotic analgesics;
• drugs to stimulate diuresis;
• nitroglycerine;
• drugs to lower blood pressure.

Depending on the underlying disease, patients with pulmonary edema are prescribed antihistamines, antibiotics, hormonal and antiarrhythmic drugs, and cardiac glycosides. The task of the resuscitator is to stop the attack and prevent acute hypoxia, which leads to cell death and death of the patient. After the symptoms of respiratory failure are relieved, treatment of the disease that caused it begins.

It is very important to eliminate the root cause that led to the clinical syndrome. Otherwise, a relapse of the disease is possible.

Consequences for life

The prognosis depends on several factors: timeliness of care, concomitant pathology and severity of the condition. The danger of the disease is the development of acute respiratory failure. Because of this, not only the respiratory system suffers, but also all organs that do not receive enough oxygen.

In many cases the prognosis is poor. Old age is one of the risk factors that aggravates the course of the disease.

With OL, patients die from asphyxia. With early treatment (at the stage of interstitial edema), complete recovery is possible. The prognosis largely depends on the cause; with cardiogenic shock or sepsis, the mortality rate is several times higher.

Predictions and prevention

Pulmonary edema is a deadly condition; Mortality with this clinical syndrome is up to 50%. Patients with anaphylactic shock most often develop fulminant or acute pulmonary edema, which in more than 90% leads to death.

The consequences of acute pulmonary failure are no less serious than the disease itself. Many patients who have suffered pulmonary edema experience ischemic damage to internal organs, the appearance of areas of pneumosclerosis, and congestive pneumonia. This affects the functioning of the respiratory system, in the organs of which irreversible changes occur. The pathology is manifested by shortness of breath, chest pain, and cough. Pneumosclerosis and other consequences of pulmonary edema require long-term treatment, can lead to disability and shorten the patient's life expectancy.

The likelihood of a favorable prognosis and outcome of the disease with pulmonary edema increases if the diagnosis was made in a timely manner and doctors began to stop the attack at the initial stage.

Pain in the lungs when coughing and breathing

Pain in the lungs, aggravated by coughing or breathing, occurs with infections of the lungs and bronchi of both bacterial and viral etiology. Often accompanied by other symptoms of infection: fever, chills, malaise, weakness, dry cough or coughing up mucus. You should consult your doctor as you may need to take an antibiotic.

Severe pain in the lungs, aggravated by coughing and breathing, also indicates problems with the pleura. This is a sharp, stabbing, well-recognized pain. If this happens suddenly, and shortness of breath or other alarming symptoms appear, you need to call an ambulance, as this may be a pneumothorax or pulmonary embolism. Pain in the pleura with pneumonia is also present, but it develops slowly, in addition, there is fever and expectoration of mucus. Back problems also increase lung pain when coughing and breathing. If pain occurs without symptoms, then you need to consult a neurologist.