Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension,[12][13] the mechanism of action is via phosphodiesterase inhibition which raises cGMP, resulting in pulmonary arterial vasodilation and inhibition of smooth muscle cell proliferation.[14] While this e ect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent has been delayed for some reason.[15]

5Management

The initial management of pulmonary edema, irrespective of the type or cause, is supporting vital functions. Therefore, if the level of consciousness is decreased it may be required to proceed to tracheal intubation and mechanical ventilation to prevent airway compromise. Hypoxia (abnormally low oxygen levels) may require supplementary oxygen, but if this is insu cient then again mechanical ventilation may be required to prevent complications. Treatment of the underlying cause is the next priority; pulmonary edema secondary to infection, for instance, would require the administration of appropriate antibiotics.

5.1Cardiogenic pulmonary edema

Acute cardiogenic pulmonary edema often responds rapidly to medical treatment.[16] Positioning upright may relieve symptoms. Loop diuretics such as furosemide or bumetanide are administered, often together with morphine or diamorphine to reduce respiratory distress.[16] Both diuretics and morphine may have vasodilator effects, but specific vasodilators may be used (particularly intravenous glyceryl trinitrate or ISDN) provided the blood pressure is adequate.[16]

Continuous positive airway pressure and bilevel positive airway pressure (BIPAP/NIPPV) has been demonstrated to reduce the need of mechanical ventilation in people with severe cardiogenic pulmonary edema, and may reduce mortality.[17]

It is possible for cardiogenic pulmonary edema to occur together with cardiogenic shock, in which the cardiac output is insu cient to sustain an adequate blood pressure. This can be treated with inotropic agents or by intra-aortic balloon pump, but this is regarded as temporary treatment while the underlying cause is addressed.[16]

6References

[1]"pulmonary edema" at Dorland’s Medical Dictionary

3

[2]Ware LB, Matthay MA (December 2005). “Clinical practice. Acute pulmonary edema”. N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.

[3]What Is Pulmonary Hypertension? From Diseases and Conditions Index (DCI). National Heart, Lung, and Blood Institute. Last updated September 2008. Retrieved on 6 April 2009.

[4]Chapter 41, page 210 in: Cardiology secrets By Olivia Vynn Adair Edition: 2, illustrated Published by Elsevier Health Sciences, 2001 ISBN 1-56053-420-6, ISBN 978- 1-56053-420-4

[5]Papaioannou, V.; Terzi, I.; Dragoumanis, C.; Pneumatikos, I. (2009). “Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema”. Journal of Anesthesia 23 (3): 417–420. doi:10.1007/s00540-009- 0757-0.

[6]O'Leary, R.; McKinlay, J. (2011). “Neurogenic pulmonary oedema”. Continuing Education in Anaesthesia, Critical Care & Pain 11 (3): 87–92. doi:10.1093/bjaceaccp/mkr006.

[7]Hampson NB, Dunford RG (1997). “Pulmonary edema of scuba divers”. Undersea Hyperb Med 24 (1): 29–33. PMID 9068153. Retrieved 2008-09-04.

[8]Cochard G, Arvieux J, Lacour JM, Madouas G, Mongredien H, Arvieux CC (2005). “Pulmonary edema in scuba divers: recurrence and fatal outcome”. Undersea Hyperb Med 32 (1): 39–44. PMID 15796313. Retrieved 2008- 09-04.

[9]Luks AM (2008). “Do we have a “best practice” for treating high altitude pulmonary edema?". High Alt. Med. Biol. 9 (2): 111–4. doi:10.1089/ham.2008.1017. PMID 18578641.

[10]Bates, M (2007). “High altitude pulmonary edema”. Altitude Physiology Expeditions. Retrieved 2008-09-04.

[11]White J, Gray M, Fisher M (1989). Atrax Robustus IPCS InChem

[12]Richalet JP, Gratadour P, Robach P et al. (2005). “Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension". Am. J. Respir. Crit. Care Med. 171

(3): 275–81. doi:10.1164/rccm.200406-804OC. PMID 15516532.

[13]Perimenis P (2005). “Sildenafil for the treatment of altitude-induced hypoxaemia”. Expert Opin Pharmacother 6 (5): 835–7. doi:10.1517/14656566.6.5.835. PMID 15934909.

[14]Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark’s clinical medicine. St. Louis, Mo: Elsevier Saunders. p. 783. ISBN 0-7020-2993-9.

[15]Fagenholz PJ, Gutman JA, Murray AF, Harris NS (2007). “Treatment of high altitude pulmonary edema at 4240 m in Nepal”. High Alt. Med. Biol. 8 (2): 139–46. doi:10.1089/ham.2007.3055. PMID 17584008.

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[16]Cleland JG, Yassin AS, Khadjooi K (2010). “Acute heart failure: focusing on acute cardiogenic pulmonary oedema”. Clin Med 10 (1): 59–64. doi:10.7861/clinmedicine.10-1-59. PMID 20408310.

[17]Vital FM, Ladeira MT, Atallah AN (2013). “Non-

invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema”.

Cochrane Database Syst Rev 5: CD005351. doi:10.1002/14651858.CD005351.pub3. PMID 23728654.

7External links

HeartFailureMatters.org Animation showing How Heart Failure causes Fluid Accumulation - Created by the European Heart Failure Association

7 EXTERNAL LINKS