Assessment of pulmonary edema: principles and practice

Assaad, S., Kratzert, W. B., Shelley, B., Friedman, M. B. and Perrino, A. (2018) Assessment of pulmonary edema: principles and practice. Journal of Cardiothoracic and Vascular Anesthesia, 32(2), pp. 901-914. (doi: 10.1053/j.jvca.2017.08.028) (PMID:29174750)

Abstract

Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred. The ideal properties of such a tool would include high sensitivity and specificity, easy availability, and the ability to diagnose early accumulation of lung water before the development of the full clinical presentation. In addition, clinicians highly value the ability to precisely quantify extravascular lung water accumulation and differentiate hydrostatic from high permeability etiologies of pulmonary edema. In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Shelley, Dr Benjamin
• Authors: Assaad, S., Kratzert, W. B., Shelley, B., Friedman, M. B., and Perrino, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Cardiothoracic and Vascular Anesthesia
• Publisher: Elsevier
• ISSN: 1053-0770
• ISSN (Online): 1532-8422
• Published Online: 19 August 2017
• Copyright Holders: Copyright © 2018 Elsevier Ltd.
• First Published: First published in Journal of Cardiothoracic and Vascular Anesthesia 3292): 901-914
• Publisher Policy: Reproduced in accordance with the publisher copyright policy