Pulmonary edema: symptoms, emergency care. Pulmonary edema: causes, symptoms, emergency care Additional information from the section

Treatment with oxygen by inhaling a gas mixture, where it is contained in a concentration of 40 to 70 percent, is called oxygen therapy. It is indicated for various conditions accompanied by respiratory failure. For the procedure, nasal catheters, inhalation masks, pillows and tents are used. Non-observance of safety rules during oxygen therapy is dangerous for the patient and medical personnel.

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Indications for oxygen therapy

Oxygen inhalations are carried out to eliminate signs (insufficient blood oxygen content) that arose in diseases of the lungs, cardiovascular system, blood, nervous system and infections. The most common pathologies include:

diseases of newborns - asphyxia (choking), intracranial trauma during childbirth, (oxygen starvation), hypothermia (low body temperature), encephalopathy, convulsive syndrome;
occupational diseases and their consequences - asbestosis, silicosis, pneumosclerosis, emphysema;
brain damage - encephalitis, meningitis, traumatic brain injury;
pulmonary pathologies - gangrene, pneumonia, pulmonary edema, air penetration into the chest (pneumothorax), trauma, tuberculosis, fibrosis;
emergency conditions - shock, coma, acute heart or respiratory failure, heat stroke, carbon dioxide poisoning, pulmonary embolism, decompression sickness, severe allergic reactions with suffocation.

Contraindications

Oxygen therapy should not be carried out in conditions that are accompanied by a sharply reduced ventilation function of the lungs:

drug overdose;
trauma or swelling of the brain with damage to the center of breathing;
deep anesthesia during the operation or the introduction of muscle relaxants (relax muscle tissue, including the diaphragm);
obstruction of the bronchial passages;
surgery on the chest or traumatic injury.

It is dangerous to use oxygen even with prolonged respiratory failure.

In such patients, the only irritant that stimulates ventilation of the lungs is precisely the lack of oxygen in the blood, since the receptors for carbon dioxide completely lose their function. If you start to inject oxygen, then this is accompanied by an external improvement - the skin becomes pink, pallor and bluish tint disappear.

In this case, edema develops in the lungs, the patient quickly loses consciousness without artificial ventilation, falls into a coma, and may die. Therefore, in the presence of chronic lung diseases, it is first necessary to investigate the carbon dioxide content in the arterial blood, and if it is increased, then the patient and the device should be prepared for mechanical ventilation when breathing stops.

Types of oxygen therapy

There are pulmonary and extrapulmonary oxygen treatments. The latter have low efficiency and are rarely used for local treatment - introduction under the skin, into the abdominal or peri-pulmonary (pleural) cavity, pleura, wound surface. Special treatments include cameras with high blood pressure () and baths with oxygen supply. For the treatment of helminthic invasions, oxygen enters the intestines.

All these methods cannot increase the oxygen content in the circulating blood, therefore, the main method of treatment in the presence of hypoxia is inhalation of a gas mixture. For oxygen therapy can be used:

oxygen cushion,
nasal catheter,
mask with valve,
tent.

Apparatus for the procedure

The oxygen therapy pillow is the simplest but unreliable method. Its effectiveness is low due to the loose fit of the funnel to the face. The pillow has the form of a bag, one of the corners of which ends in a tube overlapped by a tap.

The capacity is approximately 20 - 30 liters of oxygen, which is pumped into it from cylinders. The funnel is boiled before use and filled with wet gauze. After applying the device to your mouth, press it firmly. The patient breathes in through the mouth, and exhales through the nose.

Oxygen pillow

Oxygen cylinders are used in hospitals. They are located in special rooms, and the gas mixture passes into the chamber through special tubes. Oxygen must be humidified before use, so it is passed through the Bobrov apparatus. It is a one liter vessel filled with distilled water.

An oxygen therapy catheter is a tube with multiple holes and a rounded tip. The masks have the form of a polyethylene capsule, along their edges a seal is provided for a secure fit to the face, most often they have two valves for inhaling and exhaling the mixture.

Through defoamers

If there are signs of pulmonary edema, oxygen is passed through ethanol. This procedure is called defoaming. To obtain a solution that contains 50 percent ethyl, pure alcohol in equal proportions is mixed with distilled water and poured into the Bobrov apparatus.

The effect of such manipulation (a decrease in the release of foamy fluid from the lungs) occurs no earlier than 10-15 minutes from the beginning.

Features in children

Oxygen can be supplied through a catheter or mask, but for the child, foreign object in the airways is often of concern. Therefore, a tent is the optimal type of oxygen therapy. Sessions of oxygen supply last 15 - 25 minutes, and the intervals between them increase from 2 to 6 hours as the condition normalizes. The oxygen concentration in the inhaled air should not exceed 40%.

For premature babies, an excess of oxygen is no less harmful than a deficiency. With prolonged oxygen therapy, infants develop such a complication as damage to the retina due to vasospasm -. In especially severe cases, this becomes the cause of irreversible loss of vision.

Watch the video about oxygen therapy:

Safety during the procedure

Oxygen is an explosive substance, its mixtures with oil are especially dangerous, even slight traces of fat on the hands can lead to a catastrophe. Therefore, before carrying out the procedure, you need to know the rules for handling cylinders:

the distance to the heating devices must be at least a meter, and if fire is used, then more than five, the cylinder is protected from sunlight;
do not use hand creams before starting oxygen therapy;
oxygen can be released only with a pressure gauge showing pressure;
if damage to the body or the regulating device is found, then the use of the cylinder is prohibited.

It should also be borne in mind that when using non-humidified oxygen, the epithelial layer of the bronchi is destroyed, which leads to insufficient clearing of the respiratory tract from mucus, dust, and microbes.

If you exceed the concentration of oxygen in the mixture or conduct sessions for a long time without interruption, then the toxic effects of an overdose appear:

dizziness,
loss of consciousness
nausea,
convulsions
dry mouth
cough,
urge to vomit.

Oxygen therapy is the use of oxygen when there is a lack of oxygen in the blood. The most commonly used inhalation method of admission is a pillow, mask, nasal catheter or tent. In hospitals, cylinders of various capacities serve as a source of oxygen.

To moisten the gas, it is passed through water, and in the presence of pulmonary edema with foamy sputum, through a mixture of water and ethyl alcohol. Failure to comply with the dosage leads to complications, an excess of gas is especially dangerous for premature babies. Before starting the procedure, you must follow all the safety rules for handling oxygen cylinders.

General information

Pulmonary edema is a clinical syndrome caused by the sweating of the liquid part of the blood into the lung tissue and accompanied by impaired gas exchange in the lungs, the development of tissue hypoxia and acidosis. Pulmonary edema can complicate the course of a wide variety of diseases in pulmonology, cardiology, neurology, gynecology, urology, gastroenterology, otolaryngology. Pulmonary edema can be fatal if the necessary care is not provided in a timely manner.

The reasons

The etiological prerequisites for pulmonary edema are diverse. In cardiological practice, pulmonary edema can be complicated by various diseases of the cardiovascular system: atherosclerotic and postinfarction cardiosclerosis, acute myocardial infarction, infective endocarditis, arrhythmias, hypertension, heart failure, aortitis, cardiomyopathies, myocarditis, atrial myxomas. Often, pulmonary edema develops against the background of congenital and acquired heart defects - aortic insufficiency, mitral stenosis, aneurysm, coarctation of the aorta, patent ductus arteriosus, ASD and VSD, Eisenmenger syndrome.

In pulmonology, pulmonary edema can be accompanied by a severe course of chronic bronchitis and croupous pneumonia, pneumosclerosis and emphysema, bronchial asthma, tuberculosis, actinomycosis, tumors, pulmonary embolism, pulmonary heart... The development of pulmonary edema is possible with chest injuries, accompanied by a syndrome of prolonged crushing, pleurisy, pneumothorax.

In some cases, pulmonary edema is a complication of infectious diseases proceeding with severe intoxication: ARVI, influenza, measles, scarlet fever, diphtheria, whooping cough, typhoid fever, tetanus, polio.

Pulmonary edema in newborns can be associated with severe hypoxia, prematurity, bronchopulmonary dysplasia. In pediatrics, the danger of pulmonary edema exists in any conditions associated with impaired airway patency - acute laryngitis, adenoids, foreign bodies of the respiratory tract, etc. A similar mechanism for the development of pulmonary edema is observed with mechanical asphyxia: hanging, drowning, aspiration of gastric contents into the lungs.

In nephrology, pulmonary edema can be caused by acute glomerulonephritis, nephrotic syndrome, renal failure; in gastroenterology - intestinal obstruction, liver cirrhosis, acute pancreatitis; in neurology - stroke, subarachnoid hemorrhages, encephalitis, meningitis, tumors, TBI and brain surgery.

Often, pulmonary edema develops as a result of poisoning with chemicals (fluorinated polymers, organophosphorus compounds, acids, metal salts, gases), alcohol, nicotine, drug intoxication; endogenous intoxication with extensive burns, sepsis; acute drug poisoning (barbiturates, salicylates, etc.), acute allergic reactions (anaphylactic shock).

In obstetrics and gynecology, pulmonary edema is most often associated with the development of eclampsia of pregnant women, ovarian hyperstimulation syndrome. Possible development of pulmonary edema against the background of prolonged mechanical ventilation with high oxygen concentrations, uncontrolled intravenous infusion of solutions, thoracocentesis with rapid one-step evacuation of fluid from the pleural cavity.

Pathogenesis

The main mechanisms for the development of pulmonary edema include a sharp increase in hydrostatic and a decrease in oncotic (colloid-osmotic) pressure in the pulmonary capillaries, as well as impaired permeability of the alveolocapillary membrane.

The initial stage of pulmonary edema is increased filtration of the transudate into the interstitial lung tissue, which is not balanced by the reabsorption of fluid into the vascular bed. These processes correspond to the interstitial phase of pulmonary edema, which is clinically manifested in the form of cardiac asthma.

Further movement of the protein transudate and pulmonary surfactant into the lumen of the alveoli, where they mix with air, is accompanied by the formation of a persistent foam that prevents oxygen from entering the alveolar-capillary membrane, where gas exchange occurs. These disorders characterize the alveolar stage of pulmonary edema. The dyspnea resulting from hypoxemia helps to reduce intrathoracic pressure, which in turn increases blood flow to the right heart. In this case, the pressure in the pulmonary circulation rises even more, and the sweating of the transudate into the alveoli increases. Thus, a vicious circle mechanism is formed that causes the progression of pulmonary edema.

Classification

Taking into account the triggers, cardiogenic (cardiac), non-cardiogenic (respiratory distress syndrome) and mixed pulmonary edema are distinguished. The term noncardiogenic pulmonary edema is grouped together different casesnot associated with cardiovascular diseases: nephrogenic, toxic, allergic, neurogenic and other forms of pulmonary edema.

According to the course, the following types of pulmonary edema are distinguished:

fulminant - develops rapidly, within a few minutes; always fatal
acute - builds up quickly, up to 4 hours; even with immediate resuscitation measures, it is not always possible to avoid a lethal outcome. Acute pulmonary edema usually develops with myocardial infarction, TBI, anaphylaxis, etc.
subacute - has a wavy flow; symptoms develop gradually, then increasing, then subsiding. This variant of the course of pulmonary edema is observed with endogenous intoxication of various origins (uremia, liver failure, etc.)
protracted - develops in the period from 12 hours to several days; can be erased, without characteristic clinical signs. Prolonged pulmonary edema occurs when chronic diseases lungs, chronic heart failure.

Pulmonary edema symptoms

Pulmonary edema does not always develop suddenly and violently. In some cases, it is preceded by prodromal signs, including weakness, dizziness and headache, tightness in the chest, tachypnea, dry cough. These symptoms may last minutes or hours before pulmonary edema develops.

The clinic of cardiac asthma (interstitial pulmonary edema) can develop at any time of the day, but more often it occurs at night or in the early morning hours. An attack of cardiac asthma can be provoked by physical exertion, psychoemotional stress, hypothermia, anxious dreams, a transition to a horizontal position, and other factors. In this case, there is a sudden choking or paroxysmal cough, forcing the patient to sit down. Interstitial pulmonary edema is accompanied by the appearance of cyanosis of the lips and nails, cold sweat, exophthalmos, agitation and motor restlessness. Objectively revealed a respiratory rate of 40-60 per minute, tachycardia, increased blood pressure, participation in the act of breathing of auxiliary muscles. Breathing is increased, stridorious; on auscultation, dry wheezing may be heard; moist rales are absent.

At the stage of alveolar pulmonary edema, severe respiratory failure, severe shortness of breath, diffuse cyanosis, puffiness of the face, swelling of the veins of the neck develop. A bubbling breath is heard in the distance; auscultation is determined by different-sized wet rales. When breathing and coughing, a foam is released from the patient's mouth, often having a pinkish tint due to the sweating of the blood cells.

With pulmonary edema, lethargy, confusion, up to coma, rapidly increase. In the terminal stage of pulmonary edema, blood pressure decreases, breathing becomes superficial and periodic (Cheyne-Stokes breathing), the pulse becomes threadlike. The death of a patient with pulmonary edema occurs due to asphyxia.

Diagnostics

In addition to assessing physical data, laboratory and instrumental studies are extremely important in the diagnosis of pulmonary edema. All studies are performed as soon as possible, sometimes in parallel with the provision of emergency care:

Study of blood gases.With pulmonary edema, it is characterized by a certain dynamics: initial stage there is moderate hypocapnia; then, as pulmonary edema progresses, PaO2 and PaCO2 decreases; at a later stage, PaCO2 increases and PaO2 decreases. Indicators of CBS blood indicate respiratory alkalosis. Measurement of CVP in pulmonary edema shows its increase up to 12 cm of water. Art. and more.
Biochemical screening.In order to differentiate the causes that led to pulmonary edema, a biochemical study of blood parameters (CPK-MB, cardiospecific troponins, urea, total protein and albumin, creatinine, liver tests, coagulogram, etc.) is carried out.
ECG and EchoCG.On the electrocardiogram with pulmonary edema, signs of left ventricular hypertrophy, myocardial ischemia, and various arrhythmias are often revealed. According to the ultrasound of the heart, zones of myocardial hypokinesia are visualized, indicating a decrease in left ventricular contractility; the ejection fraction is reduced, the end diastolic volume is increased.
Chest x-ray. Reveals the expansion of the borders of the heart and roots of the lungs. With alveolar pulmonary edema in the central parts of the lungs, a uniform symmetrical darkening in the shape of a butterfly is revealed; less often - focal changes. Moderate to large pleural effusion may be present.
Pulmonary artery catheterization. Allows to conduct differential diagnosis between noncardiogenic and cardiogenic pulmonary edema.

Pulmonary edema treatment

Treatment of pulmonary edema is carried out in the ICU under constant monitoring of oxygenation and hemodynamic parameters. Emergency measures for pulmonary edema include:

giving the patient a sitting or half-sitting position (with a raised head of the bed), the imposition of tourniquets or cuffs on the limbs, hot foot baths, bloodletting, which helps to reduce venous return to the heart.
it is more expedient to supply humidified oxygen with pulmonary edema through antifoaming agents - antifomsilan, ethyl alcohol.
if necessary, transfer to mechanical ventilation. If indicated (for example, to remove a foreign body or aspirate contents from the airways), a tracheostomy is performed.
the introduction of narcotic analgesics (morphine) to suppress the activity of the respiratory center.
the introduction of diuretics (furosemide, etc.) in order to reduce BCC and lung dehydration.
administration of sodium nitroprusside or nitroglycerin to reduce afterload.
the use of ganglion blockers (azamethonium bromide, trimetaphan) allows you to quickly reduce pressure in the pulmonary circulation.

According to indications, patients with pulmonary edema are prescribed cardiac glycosides, hypotensive, antiarrhythmic, thrombolytic, hormonal, antibacterial, antihistamines, infusion of protein and colloidal solutions. After the relief of an attack of pulmonary edema, the underlying disease is treated.

Forecast and prevention

Regardless of the etiology, the prognosis for pulmonary edema is always extremely serious. In acute alveolar pulmonary edema, mortality reaches 20-50%; if edema occurs against the background of myocardial infarction or anaphylactic shock, the mortality rate exceeds 90%. Even after successful relief of pulmonary edema, complications in the form of ischemic damage are possible internal organs, congestive pneumonia, lung atelectasis, pneumosclerosis. In the event that the underlying cause of pulmonary edema is not eliminated, it is highly likely to recur.

Early pathogenetic therapy, undertaken in the interstitial phase of pulmonary edema, timely detection of the underlying disease and its targeted treatment under the guidance of a specialist of the appropriate profile (pulmonologist, cardiologist, infectious disease specialist, pediatrician, neurologist, otolaryngologist, nephrologist, gastroenterologist, etc.) contribute to a favorable outcome to a large extent. ...

Pulmonary edema is a disease characterized by pulmonary insufficiency presented in the form of mass waste transudate from the capillaries into the pulmonary region, resulting in the infiltration of the alveoli. In simple words, pulmonary edema is a process by which fluid seeps through blood vesselsstagnates in the lungs. The disease can be independent, or it can be the result of other serious ailments of the body.

The lungs are an organ that consists of alveoli filled with a large number of capillaries. In this organ, the process of gas exchange takes place, as a result of which the body is filled with oxygen, which ensures good performance of the body. If in the alveolus liquid penetrates, not oxygen - this contributes to the formation of pulmonary edema.

Important . Pulmonary edema is a dangerous illness that can have such dangerous consequences as death. The disease affects both adults and children.

Prognosis and complications of the disease

The prognosis of pulmonary edema is often poor. This is due to the reasons due to which the disease arose. Non-cardiogenic edema is easy to treat, while cardiogenic edema is very difficult to stop. Even with effective therapy for cardiogenic edema, the survival rate is only 50%. If the form is lightning, then the person cannot be saved. Toxic edema is a serious diagnosis and a favorable outcome is possible only with the use of a large number of diuretics. It all depends on individual characteristics organism.

The consequences of pulmonary edema can be very varied. Often, internal organs are damaged. The most pronounced changes occur in tissues that are more supplied with oxygen - lungs, heart, brain, liver, kidneys, adrenal glands. Violations of the activity of these organs can provoke heart failure. and even be fatal. In addition, there are such respiratory diseases:

Congestive pneumonia
Lung atelectasis
Emphysema
Pneumosclerosis.

Causes of pulmonary edema

The causes of pulmonary edema are very different, but they need to be known, since the consequences of the disease are very serious, even fatal. Most often, pulmonary edema manifests itself as a complication of a disease. The main causes of pulmonary edema include:

Acute intoxication of the body. It manifests itself as a result of the ingestion of toxic elements, both non-infectious and infectious, into the body. Toxic elements have an adverse effect on alveolar membranes. The intoxication of the body includes: excess medicines, bacterial pneumonia, drug or poisoning.
General malaise of the left ventricle. As a result of this disease, pathological abnormalities of the cardiovascular system (heart disease, myocardial infarction, angina pectoris, arterial hypertension) appear. As a result of these diseases, pulmonary edema can occur.
Chronic pulmonary disease. Among these are bronchial asthma, emphysema, pneumonia, and malignant tumors of the lung cavity.
Substantial physical activity. For example, an athlete who goes uphill may develop pulmonary edema. Often, it occurs in women - athletes than in men.
TELA... Pulmonary edema can occur due to clogging of the pulmonary arteries with blood clots. This can be fatal.
With a decrease in oncotic pressure. When pressure decreases, the amount of protein in the blood decreases, resulting in diseases such as cirrhosis of the liver and chronic hemorrhagic syndrome.
Long-term use of drugs, especially intravenous drugs, if renal excretory function is impaired.
Severe head injuries
With prolonged artificial ventilation
When vomit enters the respiratory organs. Often, this is observed in newborns with an incorrect posture during sleep.
When drowning
With the penetration of various substances into the respiratory tract.

Pulmonary edema may be cardiogenic and non-cardiogenic. Cardiogenic pulmonary edema occurs as a result of left heart failure. Failure occurs for the following reasons:

Ventricular pathology - heart disease, myocardial infarction, myocarditis, cardiosclerosis.
Pathological abnormalities of the atrium.

Important . Non-cardiogenic edema occurs as a result of an overabundance of drugs.

Pulmonary edema symptoms

Symptoms of the disease arise suddenly often at night (due to the patient's lying position):

Attacks of painful, severe suffocation, aggravated in the supine position, so the patient sits or stands. This is due to a lack of oxygen.
Shortness of breath occurs even at rest
Painful sensations in the chest due to insufficient oxygen.
A sharp increase in breathing rate (due to the stimulation of the respiratory center by not emitted carbon dioxide).
Strong heartbeat
Cough with pink sputum
The patient's face has a gray - bluish tint, and after a while it affects all parts of the body. This is due to changes in the release of carbon dioxide from the blood.
Pale skin and cold clammy sweat
Veins swell in the neck area - due to stagnation in the pulmonary circulation
Rising blood pressure
Confused patient's mind
Threaded, weak pulse

Diagnostics

In addition to a visual examination of a patient presented with the first symptoms of pulmonary edema, a specialist should conduct instrumental and laboratory research, to confirm the accuracy of the diagnosis. Diagnostics involves the following procedures:

Carrying out a blood gas test.
Biochemical blood test.
Electrocardiogram
Heart ultrasound
X-ray of the chest.

The results of the procedures performed will make it possible to determine not only the treatment regimen, but also the cause of the disease.

Pulmonary edema in children

Pulmonary edema in babies is most often manifested as a result of pathology of the cardiovascular system. It could be allergic reaction or by inhalation of toxic ingredients. Swelling can occur at any time, but most often occurs at night. The kid is worried and even scared by a significant lack of air. Among the main symptoms of pulmonary edema in children are:

Cough
Dyspnea
Foamy pink phlegm
Wheezing
Blueness of the skin

In newborn babies, pulmonary edema can occur due to such pathologies:

Placental infarction is the death of cells in a separate area of \u200b\u200bthe placenta. As a result, blood does not flow well to the fetus and hypoxia may occur.
Aspiration of amniotic fluid - penetration of amniotic fluid into the lower respiratory tract.
Prenatal or birth brain injury.
Heart defects.

First aid for pulmonary edema

Before the arrival of an ambulance, you can independently do:

Sit down the patient so that the legs are down
Provide quick access to a large peripheral vein
Arrange fresh air sweat
Organize a hot foot bath
Allow the patient to inhale alcohol vapors
Track breathing and pulse
Apply venous tourniquets to the limbs
If the pressure is not lowered, you can use 1-2 tablets of nitroglycerin under the tongue.

Algorithm for the treatment of pulmonary edema

Pulmonary edema therapy consists of 7 stages:

Sedation therapy
Defoaming
Vasodilator therapy
Diuretics
Cardiac glycosides and glucocorticoids
Blood exfusion
Hospitalization of the patient.

Basic therapy includes:

With cirrhosis of the liver, a course of hepatoprotectors is prescribed
With pancreatic necrosis, drugs are initially prescribed that suppress the work of the pancreas, and then drugs that stimulate the healing of necrosis.
Complex treatment of myocardial infarction
With bronchopulmonary diseases, a course of antibiotics is required.
With toxic edema, detoxification therapy is necessary. Salt mixtures help replenish fluid that has been lost due to the use of diuretics.
For asthma - expectorant drugs, mucolytics, bronchodilators.
For toxic shock, antihistamines
Edema of any form involves the use of potent antibiotics and antiviral drugs.

The duration of therapy for pulmonary edema depends on the form of the disease, concomitant diseases, general condition and age of the patient. Often times, the time frame can vary from 1 to 4 weeks.

Additional Information... If the edema proceeds without any complications and with effective therapy, the treatment period is no more than 10 days.

Possible consequences after emergency care:

Transition to fulminant degree of edema
Airway obstruction due to rapid foam production
Respiratory depression
Tachyarrhythmia
Asystole
Angious pain. The pain is so severe that the patient may experience painful shock.
Failure to normalize blood pressure. Often, pulmonary edema occurs with low or high blood pressure, which can alternate. The vessels cannot withstand these drops for a long period, as a result of which the patient's condition deteriorates significantly.
Pulmonary edema increases as blood pressure rises.

Prevention

Prevention is based on early detection of the disease causing pulmonary edema. Patients suffering chronic insufficiency, you should follow a diet that is based on: limiting the amount of salt and liquid consumed, avoiding fatty foods and reducing physical activity. As a result of the presence of chronic pulmonary diseases, one should constantly consult with a specialist, carry out therapy on an outpatient basis, carry out treatment in a hospital twice a year, prevent factors that can worsen the patient's condition (interaction with allergens, acute respiratory diseases, smoking cessation).

Posted June 7, 2015 4:25 am MSK by admin Category... Other respiratory diseases

The lung tissue is very vulnerable. The final structure that ensures the transfer of oxygen and the release of carbon dioxide is the smallest bubbles (acini). A slice of lung looks like a bunch of grapes. Imagine that each berry is entangled in a fine network of vessels (arteries and veins). They do the work by inhaling and exhaling.

The accumulation of fluid in the lungs (edema) is possible only when the walls of the alveoli lose their protection, increase the permeability of capillaries, and increase the pressure from the right side of the heart in the bloodstream. In this case, the lung tissue is filled not with air, but with liquid.

The physiology of injuries when filling the lungs with fluid can be divided conditionally into 3 options for reasons:

Overloading the pulmonary vessels with blood due to insufficient heart rate leads to high pressure inside. This causes the plasma to move into the surrounding space, and then into the alveoli, where fluid accumulates.
With a significant decrease in the level of protein in the blood, the body "aligns" it, transferring the liquid part from the vessels to the extracellular part of the tissue.
Possible direct damage to the wall of the alveoli (membrane), increased permeability and fluid filling.

Most often, one of the mechanisms prevails, but then the rest are connected. Fluid in the lungs leads to impaired gas exchange. Blood is not saturated with oxygen, tissues do not receive the main substrate for life. Oxygen starvation develops.

All reasons for the accumulation of fluid in the lung tissue are divided into:

associated with heart disease - this group can include all diseases leading to acute and chronic heart failure (myocardial infarction, decompensation of heart defects, hypertension, myocardial dystrophy, severe arrhythmias, pulmonary embolism), primarily weakness occurs in the left heart, which leads to stagnation in the small (pulmonary) circle and increased pressure in the pulmonary vessels;
not related to cardiac pathology - here the causes and symptoms can be very diverse.

Why noncardiac pulmonary edema occurs

Reasons that caused pathological disorders, depend on the correct activity of other organs and systems.

Toxic effect on the alveoli of bacteria and viruses in severe pneumonia.
Diseases of the liver and kidneys (cirrhosis, renal failure) in the terminal stage contribute to the loss of blood protein.
Acute exposure to vapors of toxic chemicals, inhalation and drug overdose.
Injuries that penetrate the chest with the formation of pneumothorax (air mass in the pleural cavity, compressing the lung), hemothorax (the same thing, but blood pressure).
Exudative pleurisy (tuberculous or other etiology).

Edema can provoke an excess of intravenous fluid without taking into account excretion in the urine (to relieve intoxication in acute poisoning, infectious diseases).

The development of radiology in the treatment of malignant tumors has led to such a form of edema as radiation associated with irradiation of the lung tissue.

Time classification of edema

Pathological changes are formed and lead to oxygen deficiency at different times. Therefore, the clinic distinguishes between:

edema with a fulminant course - the onset is sudden, death occurs quickly, it is impossible to prevent;
acute form of edema - it takes two to four hours for the development of symptoms, the patient can be saved by providing specialized assistanceif the disease is not associated with end-stage cancer, hepatitis, or renal failure;
a protracted form - it develops gradually, lasts more than a day.

Symptoms of oxygen deficiency begin to manifest with rapid breathing. A frequency of more than 16 per minute is called shortness of breath.

The harbingers of fluid accumulation in the lungs are nocturnal attacks of cardiac asthma (in mild forms): suffocation suddenly appears, the patient cannot lie down at all, is agitated.
The face is pale, the lips, fingers and toes are bluish.
Sticky cold sweat.
Palpitations and arrhythmias.
Pressing pains in the region of the heart radiating to the left.
The paroxysmal cough goes from dry to wet. Coughing up sputum streaked with blood.
General weakness increases, dizziness appears.
The more fluid passes into the lung tissue, the more pronounced shortness of breath, moist rales are heard at a distance.

In the terminal stage, blood pressure drops, consciousness is confused.

How to provide first aid

If the listed symptoms have arisen in a loved one or seen in a bystander, you must call an ambulance. The only thing to remember to do is to eliminate the mechanical difficulty in breathing: a tight tie, belt, unbutton the collar, and provide as much air as possible to the patient. Try to make the patient sit comfortably.

At home, before the ambulance arrives, you can give Nitroglycerin under the tongue, the symptoms of arousal are relieved with soothing drops, you can put mustard plasters on the calves of your legs. If there are expectorants, then it is better to use liquid decoctions or just hot water with honey.

If the patient is hypertensive, then you need to measure blood pressure. With increased numbers, take the tablets prescribed by the doctor or spray Isoket in the mouth.

For a patient with pulmonary edema, the doctors of the ambulance team will try to increase the low blood pressure and transport it to the hospital. Here he is placed in the intensive care unit or intensive care unit.

To improve gas exchange, it is necessary in treatment:

Constantly allow breathing an oxygen mixture with an antifoam agent (through an alcohol solution).
Fast-acting diuretics are used to remove excess fluid.
Narcotic analgesics are indicated to relieve suffocation, reduce high pressure in the pulmonary vessels.
Be sure to use drugs that increase cardiac output.

In parallel, diagnostics are carried out in order to identify the main cause of the edema.

With pneumonia, large doses of antibiotics and vascular-strengthening agents are needed.
In acute myocardial infarction, thrombolysis is performed, vasodilators are administered for the coronary arteries.

Pulmonary edema as pathological condition no doubt about the clinical manifestations. In acute development, the reason remains unclear. Identification helps to find treatment faster.

To exclude cardiac pathology, an ECG study is performed. The method allows you to identify acute heart attack myocardium and suspect its complications.
Blood coagulability and a tendency to thrombus formation are determined in a laboratory.
Liver tests, residual nitrogen, creatinine, urinary protein, and blood albumin indicate severe liver and kidney damage.
Signs of pneumonia behind a picture of general stagnation can be determined by an experienced radiologist on a radiograph.

When the patient's condition improves, other clarifying methods are possible (ultrasound, cardiac catheterization).

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

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

Oxygen therapy - oxygen treatment procedure

For the normal existence of living organisms, it is necessary that the atmosphere contains 21% oxygen. A decrease in concentration will lead to big problems, up to and including death. But pure oxygen is also dangerous. For oxygen therapy, mixtures with an increased 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:

Also, indications for the use of oxygen therapy include help in the action of certain drugs and an increase in the effect of treatment for cancer.

The first experiments in 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. The indication for the use of carbogen (95% oxygen and 5% carbon dioxide) is carbon monoxide poisoning. With pulmonary edema with the release of a foamy liquid, the gas mixture is passed through a defoamer (50% solution of ethyl alcohol).

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

Before supplying the oxygen composition to the patient, it must be moistened. There are three types of hydration:

Passage through water. The method is not very efficient. Large gas bubbles do not have time to collect enough water and its temperature drops slightly. Heating the humidifier and the use of a fine-mesh spray gun will help to correct the imperfections.
"Artificial nose". Air is passed through corrugated foil on the patient's face. The foil heats up from breathing and condenses the exhaled moisture, releasing it upon inhalation.
An aerosol inhaler is the most reliable way. It creates a suspension of the smallest water droplets in the gas composition.

Inhalation oxygen supply

Oxygen therapy can be carried out both clinically and at home. At home, you can use hubs, pillows or cylinders. These methods are indicated for long-term oxygen therapy, but only a specialist can prescribe treatment and choose a method. Incorrect use of oxygen mixtures can be dangerous!

In a clinical setting, there are the following types of filing:

Using nasal catheters. To prevent the mucous membrane from drying out, the mixture is moistened by passing it through water. The composition is fed to the patient through a nasal catheter (cannula) under a pressure of 2-3 atmospheres. The equipment includes two pressure gauges showing cylinder and outlet pressures.
Through a special mask that should fit snugly to the face. The feed mixture is also moistened.
Artificial lung ventilation apparatus. In 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, clean them if necessary;
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 petroleum jelly;
lift the tip of the nose and insert the cannula along the lower nasal passage up to back wall pharynx (the 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 with a humidified gas supply source and secure with a plaster on the cheek, forehead or neck;
open the feed valve, feed rate 2-3 liters per minute;
monitor the patient's condition within 5 minutes;
change the position of the cannula every half hour or hour to prevent pressure ulcers 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. Oxygen cushion application algorithm:

Hyperbaric oxygenation (from the Greek "heavy") combines both methods of delivery. This is a method of saturating the body with oxygen under high pressure. The method is used for therapeutic and prophylactic purposes. The sessions are held 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 was used in the past to revive newborn babies or for respiratory failure in adults. Now the widespread method of oxygenation using oxygen cocktails - patients receive gas mixtures whipped into foam or mousse. Such therapy is used for toxicosis, chronic respiratory failure, obesity, acute liver failure.
Intravascular. The blood or blood substitute transfused to the patient is pre-saturated with oxygen.
Cutaneous. This method is used most often for cardiovascular diseases, complications from injuries, wounds or ulcers. It consists in taking general or local oxygen baths.

A non-inhalation type of oxygen therapy is also used.

In addition to those listed, non-inhalation types include subcutaneous, intraarticular, intracavitary methods of performing oxygen therapy. Indications for their use are wounds, inflammation, 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, metabolic disorders can lead to hypoxia. Only a pediatrician has the right to prescribe therapy, self-treatment unacceptable!

For children, inhalation type of oxygen therapy is most often used. Oxygen tents or awnings, 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 comfortable and hardly ever used.

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

Oxygen treatment is indicated for children

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

The procedure causes anxiety in children, which can lead to impaired cardiac activity or breathing. In order to avoid complications, it is necessary to consult a specialist and observe the rules and technology of oxygenation.

Safety engineering

Oxygen is toxic in high concentrations. Up to 60% concentration, it is harmless even with long-term use... If pure oxygen is used for more than 24 hours, complications are possible: changes in the lungs, necrosis of nerve cells, 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 form an explosive cocktail with oxygen. One spark will be enough to explode the cylinder or start a fire if oxygen leaks.

Specially trained people should work with oxygen cylinders (change, connect) in compliance with safety rules. For all the seeming simplicity of the replacement algorithm, there is a great danger to life and health.