recruitment pulmonary edema
Introduction
Introduction to recurrent pulmonary edema Recurrent pulmonary edema is caused by pneumothorax, pleural effusion, huge tumor in the thoracic cavity, and collapse of the lung. Transthoracic drainage or tumor resection is performed to relieve the compression of the lungs, so that the collapsed lung can be re-expanded. Acute pulmonary edema occurs in the lungs or lungs in a short period of time (minutes to hours), called recurrent pulmonary edema, with a mortality rate of about 20%. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: respiratory failure, acute heart failure
Cause
Causes of recurrent pulmonary edema
Pathological changes resemble adult respiratory distress syndrome or pulmonary edema after lung transplantation. The pathogenesis of this disease is still not very clear, but it is generally believed that the extent of lung collapse, the length of time, the speed of lung re-expansion, the speed of chest drainage (exhaust, drainage) is too fast, the amount of primary is too large, or the application of negative pressure suction, etc. As the main cause, its age may also be one of the causes of recurrent pulmonary edema. Strong pulmonary capillary permeability may be the main cause of recurrent pulmonary edema.
Prevention
Relapsing pulmonary edema prevention
Relapsing pulmonary edema should be based on prevention, and early detection, early diagnosis and treatment, early treatment, reduction of morbidity and mortality of recurrent pulmonary edema, the key is to correctly understand the disease, especially some old and frail, Patients with malignant tumors, chronic severe abscesses, etc., often have hypoproteinemia and hypoxemia. Once recurrent pulmonary edema occurs, it is easy to cause death due to multiple organ failure. In order to prevent re-expendable pulmonary edema, the following points should be noted in clinical work: (1) For pleural effusion, gas accumulation, especially a large amount of effusion, gas accumulation, long-term pressure collapse of the lungs, effusion, product The rate of gas and thoracic closed drainage is slow, and the drainage tube is intermittently clamped or the infusion is used to regulate the drainage. The first day of drainage is 1000ml.
(1) It has been suggested that the lungs are compressed for more than 7 days, the first discharge volume is 1000ml, the first pumping is about 500ml, the first exhaust volume is 3/4 compression volume, the second day draining volume is 2000ml, the exhaust gas can be Casual
(2) Strictly grasp the indications for negative pressure suction of thoracic closed drainage. If negative pressure suction is required, the pressure does not exceed 20cmH2O (1.96kPa);
(3) When double-lumen anesthesia is performed in thoracotomy, intermittent double lung ventilation should be performed to avoid prolonged collapse of the surgical side lung. During anesthesia recovery, it is best to manually control the balloon to re-expand the lungs, the speed is slow, and the tidal volume is moderate;
(4) Control the volume of infusion and the speed of infusion, closely observe the amount of urine, and if necessary, do central venous pressure monitoring and bedside chest X-ray.
Complication
Recurrent pulmonary edema complications Complications, respiratory failure, acute heart failure
Concurrent DIC, acid-base balance disorders. The various systemic phases of each organ are both damaged and eventually lead to multiple organ failure.
Symptom
Symptoms of recurrent pulmonary edema Common symptoms Irritability, restlessness, paleness, irritability
Often sudden onset, high urgency, shallow breathing, sitting breathing, coughing, white or pink foam sputum, pale complexion, lips and limbs, forceps, sweating, irritability, palpitations, fatigue and so on. Signs include extensive blisters and/or wheezing sounds in both lungs, increased heart rate, galloping circumflex and systolic murmurs in the apex, and enlarged heart to the left, with arrhythmia and alternating veins.
Examine
Examination of recurrent pulmonary edema
(1) There is a history of pulmonary effusion, gas accumulation and other lung compression.
(2) There is chest drainage or acute lung recruitment induced by surgery.
(3) Clinical manifestations of short-term dyspnea after lung recruitment, such as severe coughing, coughing or a large amount of white or pink foamy sputum or liquid, and shortness of breath.
(4) Patients with unilateral or bilateral lungs have small blisters and increased heart rate.
(5) If the anesthesia recovery period is characterized by spontaneous breathing, the tracheal tube coughs up or sucks out foamy sputum or pink liquid.
(6) SpO2 is unstable in the early stage and then continues to decline.
(7) Imaging examination The lungs are covered with spotted, flaky blurred shadows.
Diagnosis
Diagnosis and differentiation of recurrent pulmonary edema
The protein content in the compound pulmonary edema fluid is high, and the protein ratio in plasma is 0.73, and the pulmonary capillary pressure is normal. Mostly unilateral onset, but also involving the contralateral side, clinical manifestations and cardiogenic pulmonary edema are very similar, the general diagnosis is not difficult.
