Disruption of normal gas exchange in the lungs and, as a result, accumulation of fluid can be caused by two main reasons: physiological and medicinal.
Physiological reason is as follows: performing an operation on an organ that affects the pulmonary circulation reduces the intensity of blood flow through it, stagnation of blood leads to the penetration of the liquid component of blood through the walls of blood vessels into the pulmonary alveoli.
Medicinal reason: During the postoperative period, medications are taken, some of which have a negative effect on the relationship between intrapulmonary pressure and hydrostatic pressure of the capillaries in the lungs.
There may be a violation of the norm of colloid-osmotic blood pressure due to the presence of medications in it. The result is impaired gas exchange and pulmonary edema.
Symptoms of pulmonary edema
Typically, symptoms of pulmonary edema after surgery appear suddenly. Difficulty breathing appears, the frequency of inhalations and heart contractions increases, and a dry, unproductive cough is characteristic.
Even in a half-sitting position, breathing does not become easier. Some time after the first manifestations of symptoms, a foamy mass is coughed up.
Treatment of postoperative pulmonary edema
Therapeutic measures are carried out in several directions:
- normalizing the pressure ratio in the gas environment of respirators and in small blood vessels;
- blocking processes leading to foaming and hypoxemia;
- suppression of the excited state and reduction of hyperactivity of the symptoadrenal system;
- reducing the load on the pulmonary circulation and lungs with fluid.
All these activities are carried out in a clinical setting and under the supervision of medical workers. To reduce foaming, inhalation of ethyl alcohol vapor through an inhaler is often used. The pressure ratio is equalized by an anesthesia machine under a certain pressure.
The excited state is relieved by intravenous administration of sedatives - midazolam, sibazone, droperidol or sodium hydroxybutyrate. The easiest way to reduce the load on the small circle is to apply venous tourniquets or pneumatic cuffs.
POSTOPERATIVE PULMONARY EDEMA
Pulmonary edema (PE) during and after surgery was until recently considered one of the most severe complications, a pulmonary manifestation of heart failure or hyperinfusion. Its occurrence is due to the transition of the liquid part of the blood from the pulmonary capillaries into the air spaces of the respirons due to a change in the normal relationships between the hydrostatic pressure in the capillaries and the oppositely acting intrapulmonary pressure, as well as colloid-osmotic blood pressure.
As a result of significant changes in these factors, the pressure gradient between the microvessels of the lungs and the gaseous environment of the diffusion zone of the lungs, which, in fact, represents the pulmonary interstitium, decreases.
An increase in the permeability of the alveolocapillary membrane under the influence of various humoral factors in complicated postoperative periods (BAS, other ETS), as well as the use of prolonged aspiration from the bronchial tree during its sanitation, contributes to the initial transition of intravascular fluid containing protein into the gaseous environment of the lungs. Water on the surface of the pulmonary diffusion membrane eliminates the surface-active properties of lung surfactant (Johnson J.W.C. et al. 1964), which sharply reduces lung compliance and increases energy expenditure for breathing.
The transition of significant amounts of surface-active phospholipid and protein into the liquid exuding into the lumen of the respirons contributes to the formation of persistent foam filling the air-bearing zone of the lungs, which is considered a manifestation of alveolar OJI (Luizada A.A. 1965). Filling the airways with foam further disrupts the distribution of gas in the lungs and extremely reduces the efficiency of pulmonary gas exchange with a significant increase in energy expenditure on breathing.
The specific genesis of early postoperative AL is complex. Hyperactivation of the sympathoadrenal system, especially with insufficient analgesia, an increase in the level of so-called traumatic mediators and MSM, an acute decrease in blood COP under the influence of excessive infusion of saline solutions against the background of plasma albumin deficiency, the direct effect of hypoxia and venous hypoxemia, acidosis, hyperenzyme on the permeability of pulmonary capillaries in combination with a decrease in cardiac performance - can be combined in each specific case of OL after surgery in various combinations.
Nowadays, most resuscitators are inclined to believe that the hemodynamic causes of early acute acute illness play a significant role only in patients with initial toxic or metabolic damage to the myocardium, concomitant valvular heart disease, or direct trauma to the myocardium during cardiac surgery.
Often, acute hypertension of the pulmonary circulation develops secondarily and can be associated with direct damage by factors of acute respiratory failure (hypoxemia, hypercapnia, acidosis) of the disabled heart muscle. This disorder clearly manifests itself against the background of increased systemic vascular resistance due to low BCC or, conversely, high blood pressure in the systemic circulation, which can be realistic in the immediate postoperative period. Early clinical observations of pulmonary surgeons A.D. Yarushevich (1955), I.S. Kolesnikova (1960) emphasize that the development of OA usually coincided with the period of greatest instability of pulmonary gas exchange in such patients: after lung resection, it occurred in the first hours and no later than the first day after the intervention.
Later postoperative OJI develops not only against the background of hemodynamic disorders (with a significant decrease in IOC), which is accompanied by other postoperative complications, such as bilateral pneumonia or pneumonia of a single lung, acute myocardial infarction.
OJI often result in severe protein deficiency with extreme hypoproteinemia, infectious-inflammatory endotoxicosis, or decompensation of concomitant hypertension due to cerebrovascular accident. Such OJIs develop slowly through a stage of interstitial edema with fluid retention in the peribronchial tissue. The intensity of water accumulation in the lungs largely depends on the magnitude of systemic blood pressure (hypertensive crisis) due to an increase in the rate of filtration of tissue fluid from the bronchial vascular system (Simbirtsev S.A. Serikov V.B. 1985).
Clinic and diagnostics. In many cases, the initial stage of postoperative OJI occurs suddenly. Only sometimes it is preceded by a typical syndrome in the form of a feeling of pressure behind the sternum, a feeling of lack of air and a particularly dry, unproductive cough. But soon the patient assumes an orthopneic position. Inhalation is difficult, requires significant physical effort, tachypnea is more than 40 per minute. On auscultation, breathing over the lungs is initially harsh, often accompanied by an unproductive cough. In this case, tachycardia increases, despite the absence of reasons for hypovolemia. A rise in systemic blood pressure, and sometimes central venous pressure, as well as moderate dilation of the pupils, indicating excessive activation of the sympathoadrenal system, complete the picture of complications.
Against the background of the advanced stage of OA, percussion reveals high tympanitis over the pulmonary fields, especially over their upper sections; a huge number of moist rales are heard, which are sometimes heard at a distance. The heart sounds of such a patient are barely distinguishable. Breathing quickly becomes bubbling with the discharge of white, yellowish or pink foamy sputum, the amount of which can reach 2-3 liters within 1-2 hours.
In the terminal stage of OJI, against the background of confusion or loss of consciousness, cyanosis of the skin, bubbling breathing, sometimes agonal type and the release of a large amount of sputum, extreme tachycardia (140-180 contractions per minute) is recorded, and sometimes, on the contrary, bradycardia, unstable systemic blood pressure is recorded at background of a persistent and significant increase in central venous pressure.
With pulse oximetry and laboratory monitoring in the initial stage of OD, arterial hypoxemia is combined with significant hypocapnia, and in the terminal stage, hypocapnia is replaced by hypercapnia shortly before death. During X-ray monitoring of the lungs, inhomogeneous shading, previously recorded in the lower parts of the lungs, gradually fills all lung fields. If this patient has a pulmonary artery catheterized for intensive monitoring of hemodynamics or it is possible to use such access for monitoring as needed (via a central venous catheter), pulmonary capillary pressure (wedge pressure) is examined. At the height of the true alveolar OJI it turns out to be above 28-30 mm Hg.
Treatment.
The main directions of therapy for postoperative acute illness consist of therapeutic measures that provide several areas of therapeutic effect:
- restoration of the normal pressure ratio in the pulmonary capillaries and the gas environment of the respirators;
— elimination of foaming and hypoxemia;
— relieving excitement and hyperactivity of the sympathoadrenal system;
- reducing fluid overload of the small circle and lungs;
these effects are complemented by measures to reduce plasma hydration and restore COP, normalize the permeability of the alveolocapillary membrane.
O2 inhalation through an anesthesia machine under a pressure of 10-15 mm Hg. (14-20 cm water column) or another device that provides diabetes with PD is used in cases of OJI when the complication is predominantly hemodynamic in origin. An excessive increase in pressure in the respiratory tract (above 18-20 mm Hg) is unacceptable, since significant resistance to blood flow in the pulmonary capillaries and impaired filling of the right atrium increase hemodynamic disorders in such patients.
Often, treatment for OJI begins with eliminating foaming and restoring the activity of pulmonary surfactants. The most accessible way for this purpose is considered to be inhalation of ethyl alcohol vapor, which is obtained by passing 02 through 96° ethanol poured into a conventional bubble humidifier. Such a gas mixture enriched with ethyl alcohol and oxygen is supplied to the patient through nasopharyngeal catheters.
The duration of a session of such inhalation is 30-40 minutes with 15-20 minute breaks. When using an oxygen-air mixture during SD with PD, ethanol is poured into the evaporator of the anesthesia machine. Less often, in more difficult conditions, they simply pour 2-3 ml of ethyl alcohol into the trachea with a syringe by puncturing the thyroid-cricoid ligament, especially if the patient’s consciousness is inhibited. It is also possible to use inhalation of an aerosol of 20-30% aqueous ethanol solution created by an ultrasonic fogger.
The polysiloxane derivative, antifomsilane, extinguishes lung foam most effectively. The defoaming effect in such circumstances depends on compliance with the basic conditions of its use: rapid nasotracheal aspiration of foam from the trachea and gradual adaptation to inhalation of the drug. Oxygen therapy with defoaming antifomsilan for 15-20 minutes can reduce the phenomena of pronounced alveolar OJI, which rightfully allows us to classify this drug as a specific analeptic.
Quick relief of alveolar OJI allows you to conduct the necessary examination of the patient in a calm environment and establish with a certain degree of probability the cause of the complication. Adynamic patients tolerate inhalation of antifomsilan easily; in severely agitated patients, inhalation of the antifoam agent is difficult and therefore ineffective.
Mental agitation at this stage is eliminated by intravenous administration of midazolam (dormicum, flormidal) 5 mg, less often sibazon (up to 0.5 mg/kg BW of the patient), sodium hydroxybutyrate (70-80 mg/kg BW), even less often droperidol (up to 0 .2 mg/kg BW) or 2-3 ml of thalamonal in adult patients, supplementing sedation with antihistamine H-blockers (diphenhydramine, diprazine).
The long-standing recommendation to use intravenous morphine against the background of a developed picture of OJI in agitated patients has sufficient functional grounds: in addition to the sedation necessary in such cases, this opiate at a dose of 10-20 mg causes an increase in the tone of the respiratory bronchioles, creating a higher level of pressure in the diffusion zone of the lungs.
Antihistamines also have a pathogenetic effect, namely, they reduce the permeability of the alveolocapillary membrane. For this purpose, GCS (prednisolone, dexomethasone), vitamins P and C in significant doses, as well as a 30% urea solution at the rate of 1-1.5 g/kg BW of the patient are also prescribed.
Infusion of a solution of lyophilized urea (in the absence of azotemia!), unlike the infusion of mannitol or sorbitol, does not create an overload of the vascular bed, is well tolerated by patients and not only compacts the alveolar capillary membrane of the lungs, promotes the resorption of edematous fluid into the blood, but also has a positive inotropic effect on the myocardium.
Excessive intravascular fluid volume is reduced with saluretics (40-60 mg Lasix, 20 mg Unat, 1-2 mg Bufenox intravenously) in combination with measures that reduce blood flow to the right heart:
— application of venous tourniquets (preferably pneumatic cuffs) on the limbs for 25-30 minutes;
- controlled hypotension (arfonade, nitroglycerin, less often pentamine), especially with a hypertensive blood pressure reaction against the background of OJI;
- a common blockade with local anesthetics when the patient has a catheter in the epidural space, placed for other purposes.
The effect of saluretics, especially Lasix, is determined not only by their diuretic effect: often the symptoms of OJI subside even before the diuretic effect of the drug appears. With a high hematocrit, bloodletting with the preparation of autologous blood on a citrate preservative and the replacement of part of the removed blood with oncotically active blood substitutes is especially indicated.
If there is evidence of overhydration of the body against the background of normal or reduced intravascular volume and hypoalbuminemia, it is advisable to use concentrated protein blood substitutes with subsequent mild vasoplegia. HF (less commonly, isolated blood ultrafiltration) sometimes has a decisive effect in removing a patient from OJI, especially one who is resistant to conventional therapy. It is indicated for low hematocrit and clear signs of tissue hyperhydration with a high blister test.
Often, based on the “respiratory” genesis of early OJI, with the progression of respiratory failure (tendency to hypercapnia, mixed acidosis, development of edema-pneumonia), confusion, a decision should be made to transfer the patient to controlled mechanical ventilation in the PerPD mode (Castanig G. 1973) with using midazolam, diazepam, rohypnol or steroid anesthetics (altesin) for endotracheal intubation.
The occurrence of OA in the late postoperative period usually occurs against the background of persistent other pulmonary or extrapulmonary life-threatening complications: pneumonia, coma, sepsis, etc.
In these cases, preference should be given to controlled mechanical ventilation with PEEP (Kassil V.L. Ryabova N.M. 1977) in a rare rhythm (14-18 cycles per minute) with a high DO (at least 700 ml in an adult patient) and high Fi02 , which decreases as arterial hypoxemia resolves.
This mode makes it possible to achieve effective oxygenation of blood in the lungs and resorption of edematous fluid from the surface of the pulmonary diffusion membrane, reduces the filling of the pulmonary bloodstream and reduces the patient’s energy consumption for ventilation, which cannot be achieved by any method of SD in the PD mode. In such cases, there is no need to suction foamy fluid from the airways. Therapy of late postoperative OJI using mechanical ventilation with PEEP should be supplemented with measures to increase the COP of blood plasma, stabilize myocardial contractility, and prevent pulmonary infection.
Sometimes a clinical picture resembling OA can be a consequence of the so-called “silent” regurgitation, the frequency of which can be 8-15% of all patients operated on under general anesthesia with the protective pharyngolaryngeal reflexes turned off (Blitt et al. 1970; Turndorf et al. 1974). Regurgitation of gastric contents most often occurs in emergency abdominal surgery, when the possibility of preparing the gastrointestinal tract is limited, but it can also occur in patients who are well prepared for planned operations.
“Silent” regurgitation is facilitated by difficult expiration with increased intra-abdominal pressure, esophagectasia or a large esophageal diverticulum, as well as the use of depolarizing muscle relaxants for tracheal intubation without special measures to prevent fibrillation of voluntary muscles during the introduction of anesthesia, for example, the use of precurarization with a non-relaxing dose of one of the non-depolarizing relaxants (pavulon, arduan).
Postoperative pulmonary edema. Pulmonary embolism after surgery
Aspiring thoracic surgeons Retention of sputum when it is difficult to cough up in the first days after surgery is often mistaken for pulmonary edema. If, during lung resection, bronchiectasis is only partially removed, which is especially often observed with bilateral lesions, then the patient continues to separate sputum, but cannot cough it up due to the weakness of the cough impulse and pain.
As a result sputum accumulates in large bronchi and trachea and gives a picture of bubbling breathing. It can be heard at a distance, and upon auscultation it manifests itself in the form of coarse bubble-like moist rales more along the midline of the chest. To free the airways from pus, you need to create a drainage position: raise the pelvis, and lower the upper half of the patient’s torso and head towards the bed so that the angle of inclination of the torso to the horizontal reaches 45-60°.
Not paying attention attention in response to the patient’s groans, you need to force him to cough vigorously in this position and after several large spits of sputum are expelled, breathing immediately becomes free and all the phenomena of “pulmonary edema” disappear. It is even better to suck out the sputum through a bronchoscope.
Unfortunately this complication may not end so harmlessly if there is a large active purulent focus in the remaining lung. At the beginning of 1950, one of our patients literally choked on mucus secreted from bronchiectasis of the second lung, to which we did not attach due importance before the operation.
This case served us as a good lesson for the future regarding strict testing of the “healthy” lung and the need for preoperative preparation to eliminate bronchitis.
Pulmonary embolism In recent years, it has increasingly appeared in the statistics of foreign surgeons as one of the causes of death after pulmonary resection. They are gradually becoming one of the first places, as other fatal complications are becoming less and less common.
Pathogenesis of thromboembolism is still not well understood. According to B.K. Osipov, G.F. Nikolaev and our own observations, pulmonary embolism is more common in older people, after particularly complex and lengthy operations, and in patients with low functional indicators of the cardiovascular and respiratory systems.
In domestic literature Only isolated cases of pulmonary embolism after lung surgery have been described. B.K. Osipov had one patient die from this complication. G. F. Nikolaev points to a case of thromboembolism after a severe pneumonectomy operation, which also ended in the death of the patient. At the Institute of A. V. Vishnevsky (A. I. Smailis) there were eight patients with pulmonary embolism after lung surgery, six of them died.
At the same time, only one patient died from a chronic suppurative disease, and seven died during operations for lung cancer.
In most cases pulmonary embolism develop suddenly, amid relative prosperity. Less commonly, they complicate cardiopulmonary failure. Development time: first week after surgery.
The accumulation of fluid in the lung tissue, or pulmonary edema, is a serious condition that requires medical intervention and long-term treatment. The rate at which the disease develops depends on the causes and the body’s immune system.
Sometimes it can take several weeks before the first symptoms appear. Acute edema develops in just a few hours.
The causes of the disease can be not only pulmonary diseases, but also pathologies of other organs. Before prescribing treatment, your doctor will need to determine the causes and symptoms of fluid in the lungs.
Symptoms and causes of pathology
When fluid accumulates in the lung tissues, symptoms appear that cannot be ignored. The very first sign that occurs when fluid accumulates in the lung tissues is pain in the sides and under the ribs, followed by shortness of breath. These symptoms can occur at any time, even in a calm state, without physical activity.
With further development of the disease, a cough may appear, initially minor, which can be attributed to a cold. Over time, when you cough, mucus begins to come out.
Simultaneously with these processes, tachycardia, nervous exhaustion develop, and headaches often occur. Fluid in the lungs provokes oxygen starvation, as a result of which paleness and blueness of the skin are observed.
Minor symptoms include:
- Frequent hiccups.
- Sharp pain in the abdominal area.
- Bloating.
- Tension in the abdominal muscles.
- Unusual sensations when swallowing.
The more fluid appears in the lungs, the stronger the symptoms become, causing the patient’s overall health to become worse. Pulmonary edema is a fairly serious disease and if you have these symptoms, you should consult a specialist. The development of the disease can cause irreversible health consequences, and even lead to death.
Why does water form in the lungs? Fluid in the lungs always accumulates due to some reason, and never develops as an independent disease. Most often, this disease occurs as a consequence of bacterial and viral lung diseases or chest injuries.
The following processes can provoke fluid accumulation in the lungs:
To determine the reasons why fluid may be collecting in the lungs, examinations are prescribed to determine the water level and the extent of the disease.
Diagnosis and treatment
What to do when symptoms of excess fluid in the lung tissue occur? Of course, consult a doctor: a therapist or pulmonologist, who will prescribe a number of necessary examinations. Determining the accumulation of fluid in the lungs is very simple; just take a chest x-ray. After confirming the diagnosis, it is necessary to undergo an ultrasound examination to determine the amount of water in the lungs.
Tests are taken without fail: blood for a general analysis and for coagulation. When the cause remains unknown, a number of additional examinations are prescribed:
How to remove fluid from the lungs?
If the disease develops sharply, the patient is connected to a ventilator and examined to determine the causes. After examining the patient and conducting the necessary research, the doctor determines how to remove fluid from the lungs.
Treatment of diseases accompanied by fluid accumulation in the lungs depends on the severity of the disease and the causes of its occurrence. In some cases, treatment at home is possible, but most often, in order to remove water from the lungs, it is necessary to go to the hospital, where complex therapy will be prescribed.
The main goal of treatment is to remove water, relax muscles and relieve inflammation in the lung tissue. In most cases, it is not the lungs themselves that need to be treated, but other organs and systems of the body. When the cause is eliminated, the fluid level in the lung tissues will return to normal.
Drug treatment
For a disease caused by disturbances in the functioning of the heart, diuretics (Furosemide), bronchodilators (Eufillin) and cardiac drugs (Nitroglycerin, Validol) are prescribed. Diuretics help remove excess fluid from the entire body, including the lungs.
Bronchodilators relieve spasms and reduce the load on the respiratory muscles. Analgesics, for example, Morphine, have the same properties.
If water has entered the lungs as a result of intoxication and infectious diseases, it is necessary to take antibacterial agents and drugs that remove toxins and decay products of pathogenic microorganisms from the body. To prevent blood stagnation in the pulmonary veins, Nitroglycerin is prescribed, which also helps relieve stress on the heart muscles.
As an additional therapy, nootropic drugs are prescribed to prevent and treat hypoxia caused by lack of oxygen. In some cases, gas inhalations are used to increase the level of oxygen entering the blood.
For the treatment and prevention of edema after a chest injury, painkillers are prescribed, physiotherapy is performed, and the chest cavity is drained.
If water begins to enter the lungs due to cirrhosis of the liver, emergency treatment with diuretics and drugs that reduce sodium levels in the blood is necessary. In severe cases of cirrhosis, a liver transplant is required, otherwise pulmonary edema will constantly recur even during treatment.
In severe pathologies, fluid is found not only in the lungs, but also in the pleural cavity. Even a slight deviation from the normal water level requires immediate intervention. In case of pleurisy, it is necessary to pump out the exudate using a special catheter.
Pleurocentesis is the pumping out of excess fluid from the pleural cavity. The procedure is performed under local anesthesia and does not take much time. After a thoracentesis, there is no guarantee that fluid will no longer accumulate. In some cases, pleurodesis is used - pumping out water and filling the cavity with medications that prevent relapses of the disease. During these procedures, the collected exudate is taken for histology, when the causes of edema are malignant and benign formations.
Alternative medicine
When excess fluid is diagnosed in the lungs, treatment with folk remedies is possible, but only after consultation with your doctor. In alternative medicine, to relieve pulmonary edema, recipes are used, the action of which is based on the removal of water from the body, general strengthening and improvement of blood supply in the body.
During treatment, it is necessary to include lingonberry infusion, cranberry juice, and green tea in the diet. These drinks help remove excess fluid from the body. Raspberry, beet and bread kvass and fresh juices from carrots, rowan berries, currants and plums have the same effect.
Herbal infusions should be taken with caution, especially by people with a history of allergies. It is worth remembering that allergies can appear suddenly due to the body’s weak resistance during illness.
Folk remedies are used only as an auxiliary therapy, to alleviate the condition and speed up recovery. The main treatment should be medication, inhalation and physiotherapy.
Water in the lungs occurs in pathological conditions that are associated with diseases of various organs.
The accumulation of fluid in the tissues of the respiratory system requires immediate medical attention.
Find the answer
Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.Reasons for appearance
Fluid appears in the lung cavity due to damage to blood vessels or due to an increase in their permeability. As a result of such processes, the liquid part of the blood from the vessels seeps into the lung tissue, and the alveoli are filled with this liquid.
There are a number of reasons leading to this. There are also incompletely studied factors that, according to some scientists, can activate the appearance of water.
Reasons for the appearance of fluid:
In addition to these reasons, fluid seeps into the lungs under the influence of viruses and systemic autoimmune diseases.
Symptoms of pathology
The main symptom of fluid stagnation is shortness of breath. It occurs due to the fact that the blood is not sufficiently saturated with oxygen. With a small amount of fluid, shortness of breath is moderate, but as the lungs fill with fluid, breathing difficulties intensify. The patient's breathing is frequent and difficult when inhaling.
Symptoms vary depending on the location of the fluid and its volume. The greater the volume of fluid, the more pronounced the symptoms.
The most common signs:
- Attacks of suffocation;
- Frequent shortness of breath. It appears spontaneously and without any prerequisites, more often in the morning;
- Rapid breathing;
- Lack of air;
- Pain in the chest area, aggravated by coughing;
- Cough with mucus, sometimes blood;
- Numbness of hands and feet;
- Dizziness, tachycardia;
- Bluish color of the skin due to oxygen starvation;
- Sometimes anxiety, nervousness, and nervous disorders appear.
The most dangerous consequences are attacks of acute suffocation, which require immediate medical attention.
Useful information on video
Diagnostics
Only a doctor can diagnose this condition. After seeking medical help, the patient is sent for a chest x-ray. This procedure allows you to obtain accurate information about the presence of water in the lungs. To determine the volume of accumulated fluid, perform an ultrasound.
Determining the reason for its accumulation is a little more difficult; this will require additional research:
- Blood clotting tests,
- Blood chemistry,
- Analysis of its gas composition.
They diagnose diseases of the heart and pulmonary artery, and prescribe a computed tomography scan.
Disease treatment regimens
All therapeutic measures are based on the following principles:
- Treatment is being carried out for the disease that led to the formation of fluid in the lungs. Surgical interventions may be required to treat it.
- The correct work and rest schedule is established. With a stable course of the disease, the regimen changes slightly; with a progressive disease, bed rest is provided, taking into account the age category of the patient.
- Proper nutrition and diet are introduced, including food restrictions and one fasting day per week.
- Medicines are used that remove fluid from the lungs and improve the general condition of the patient.
- Physical activity is introduced in the form of exercises specifically designed to maintain the tone of the cardiovascular system.
Sometimes sanatorium treatment is prescribed to improve the general vital functions of the body and maintain tone.
How to treat certain diseases
When prescribing treatment measures, the doctor takes into account the severity of the disease and the cause that caused the appearance of fluid in the lungs.
For each specific type of disease, different treatment measures are carried out.
Treatment of pneumonia is carried out with antibacterial drugs in combination with anti-inflammatory drugs.
Depending on how difficult it is for the patient to breathe and the volume of fluid, specialists decide on the advisability of performing a pulmonary puncture.
If such an event is necessary, the doctor makes a puncture in the area of the upper edge of the rib. This manipulation is performed using ultrasound equipment to avoid damage to the lungs.
The liquid is not completely pumped out. Complete aspiration (pumping out fluid) can be performed if pus is detected.
If after these procedures pus re-forms and accumulates in the lungs, then this is a direct indication for flushing the pleural segment.
In the case of lung cancer, surgical removal of the tumor is performed. Before this, no surgical interventions can be performed to remove fluid in the presence of oncology. Therapy during this period is reduced to the use of medications.
For this use:
- Drugs that remove fluid from the body along with urine (diuretics),
- Drugs that enhance myocardial contraction
- Dilates the muscles of the bronchi.
Treatment after a heart attack and heart failure involves the administration of thrombolytics that can dissolve a blood clot. The drugs are injected into the bloodstream, reducing the load on the heart, stimulating blood flow and blocking the risk of a second heart attack. Importance is given to stabilizing blood pressure.
After surgery on the lungs, swelling often appears.
To prevent this, it is necessary to immediately establish a normal ratio of the pressure of the capillaries and the gaseous environment, reduce foaming and relieve the internal excitability of the body after surgery.To do this, doctors use ethyl alcohol vapor, which is given to the patient through nasopharyngeal catheters. To stop the body from becoming overly agitated, a drug called midazolam is given intravenously.
Sometimes it is necessary to reduce the intravascular volume of fluid; adapted drugs are used for this purpose.
In case of renal failure, water is removed from the lungs using a device (this can be a catheter or a fistula). This event is called dialysis.
Prognosis of life with illness
If you contact specialists in a timely manner and follow all treatment programs and recommendations, the prognosis is positive. How long they live with water in their lungs depends on each specific case, the characteristics of the patient, his medical history and attitude towards his health.
You need to do fluorography regularly.
When working with harmful substances, use a respirator, regularly examine the body comprehensively, and if chest pain and spontaneous shortness of breath occur, immediately seek medical help.
Treatment of pathology in older people
Before starting treatment for the disease, the patient undergoes a thorough diagnosis: blood tests, x-rays, ultrasound and computed tomography. After diagnosis, the doctor will be able to determine the correct set of treatment measures for each elderly person individually.
Therapy is applied taking into account the history and severity of the disease.
- In case of heart failure in an elderly person, you can get rid of swelling in the lungs with the help of diuretics. They are used in combination with cardiac medications. As a result, the functioning of the heart and respiratory organs improves in a person.
- If the lung tissue is infected by harmful microorganisms, then the best way to combat them is antibiotics. In the initial stages of pneumonia, these drugs are administered internally (in the form of injections). The attending physician prescribes expectorants.
- In case of pleurisy, it is possible to remove fluid only by using complex treatment: antibiotics + antitussive medications.
- In older people, fluid accumulates in the lungs due to traumatic injuries. The diagnosis requires immediate chest drainage. The patient should stop taking liquids for a while.
- When the rhythm of the heart changes, the blood in the lungs stagnates, forming an excess of liquid. Treatment is with digoxin or metoprolol. These medications can optimize a stable heartbeat. Diuretics are used to remove excess fluid.
- The pulmonary alveoli may become filled with fluid due to brain disorders. The pressure of the blood vessels increases, the blood stagnates and the lung tissue experiences additional stress. The doctor lowers the blood pressure with furosemide. Then prevents foam in the lungs using an alcohol solution.
- If swelling of the lungs is caused by renal failure, the doctor prescribes a special diet, medical therapy and restoration of electrolyte balance.
Water in the lungs is a serious cause for concern. As soon as the chest is compressed by heaviness, pain and shortness of breath, it is necessary to immediately conduct an examination!
Help from traditional medicine
If water accumulates in the lung tissues, the patient must be hospitalized immediately; it poses a threat to human life. If the patient's condition improves, then traditional medicine methods can be applied.
Let's consider the most effective means in the fight against pulmonary edema:
- A decoction of anise seeds. Dissolve 200 grams of honey in a water bath, add 3 teaspoons of anise seeds and leave on the fire for fifteen minutes. Then add 0.5 tsp of soda. Take the medicine daily, 3 times a day, one teaspoon.
- Flaxseed, decoction. Boil 2 liters of water, add 8 tbsp. spoons of flaxseed. The infusion should steep for five hours. Strain the mixture and take one tablespoon on an empty stomach.
- A decoction of cyanosis root. Pour the crushed cyanosis root into one liter of water and place the mixture in a water bath. When the medicine has cooled, strain. Take fifty milliliters of the mixture every day.
- Healing honey tincture. Buy natural honey, butter, lard, 100 grams of cocoa and twenty milliliters of aloe juice. Mix everything, heat, but do not bring to a boil. To make the medicine taste more pleasant, dissolve it in a glass of hot milk before taking it. Use 2 times a day, one teaspoon.
- Aloe medicine. Grind aloe leaves (150 grams) and mix with honey (250 grams) and Cahors (300 grams). Infuse the mixture for 24 hours in a dark place, consume one teaspoon 3 times a day.
- Regular parsley can quickly remove accumulated water from the lungs. To do this, you need to purchase fresh parsley branches (400 grams), put them in a container and fill them with milk, preferably homemade (500 grams). Then place the future medicine on the stove and organize the boiling process over low heat. When the liquid is halved, set the container aside. Take a tablespoon of the decoction every 2 hours.
Removing fluid from the lungs is a difficult and time-consuming process. There is no need to neglect treatment; you should immediately seek help from a medical facility. There is no need to take medications on your own without examination; the slightest mistake can cost the patient’s life.
Possible complications and consequences of the disease
If fluid in the lungs accumulates in small quantities and the treatment is carried out in accordance with the prescription of the attending physician, then the body will not be harmed and there will be no consequences. With a complex course of the disease, a severe complication may follow, which will lead to painful symptoms and the development of other diseases.
Untimely removal of fluid from the pleural cavity can cause:
- Impaired elasticity of the lungs;
- Deterioration of gas exchange and oxygen starvation;
- Brain dysfunction;
To prevent dangerous consequences and complications, preventive procedures should be carried out in a timely manner that will significantly reduce the risk of fluid formation in the pleural cavity.
Preventive methods of the disease and further prognosis
It is impossible to completely protect your body from the accumulation of water in the lungs. By following some tips, there is a high chance of maintaining healthy lung tissue.
- In case of heart diseases, conduct systematic examinations and listen to the doctor’s advice;
- Allergy sufferers are susceptible to swelling of the lungs, so you need to constantly have antihistamines with you;
- The development of the disease can be influenced by chemicals, so when working with harmful factors it is necessary to regularly carry out preventive examinations and work only with a respirator.
A huge danger and risk of disease comes from nicotine. A cigarette is the first catalyst that causes dangerous diseases of the lungs and the whole body. If there is the slightest chance of fluid appearing in the lungs, stop using nicotine!
The life expectancy of people with fluid in their lungs depends entirely on their attitude to their health. Doctors are confident that if you seek help from a medical institution in a timely manner, follow treatment programs and the doctor’s prescription, then the prognosis for pulmonary edema is favorable.
A prognostically negative group of complications after heart surgery are reactive inflammatory and infectious processes in the heart (pericarditis, cardiac abscess), mediastinum (mediastinitis) and pleural cavities (pleurisy, pneumonia).
The incidence of infectious complications after cardiac surgery for infective endocarditis of the heart valves is especially high. Thus, Yu. L. Shevchenko and S. A. Matveev (1996), summing up the results of surgical treatment of 184 patients with infective endocarditis, state that one of the main immediate causes of death (33.3%) are infectious complications: purulent pericarditis, mediastinitis, pleural empyema, septic pneumonia. Postoperative mortality in this case is 29.3%.
V. I. Burakovsky et al. (1972) purulent infection after cardiac surgery in patients with acquired heart defects occurs in 16% of cases. Currently, the frequency of such complications has been reduced, however, given their thanatogenetic significance, infectious and inflammatory complications should be closely monitored in any cardiac surgery hospital.
In addition to asepsis violations, there are many factors contributing to their development. Unusually long duration of the operation, extensive tissue trauma, the volume of which largely depends on the type and characteristics of the surgical approach, artificial circulation and hypothermia, which are usually accompanied by anemia, hypoproteinemia, pathological changes in leuko-, lympho- and monocytes of the blood - all this disrupts the immune response and creates additional conditions favorable for infection of the body. It is known that with prolonged hypoxia, infectious complications occur several times more often.
Among the causative agents of purulent inflammation after cardiac surgery, the leading ones are staphylococci, often in combination with Pseudomonas aeruginosa, as well as streptococci. The vast majority of wounds, even after “clean” operations lasting more than 1 hour, are colonized by microbes that enter their surface from the skin, from the air and other sources. The main sources of infection in a surgical hospital are carriers of pathogenic staphylococcus among staff and patients.
Staphylococcal and streptococcal wound infections are characterized by widespread necrotic changes in tissue around reproducing microbes due to the action of an exotoxin. Necrotic tissues undergo purulent melting, in which the leading role is played by lysosomal proteolytic enzymes of leukocytes, and therefore a large amount of pus accumulates on the surface of the wounds. The high activity of hyaluronidases of these pathogens allows them to penetrate through connective tissue structures into the depths of tissues, which leads to the development of widespread phlegmons, abscesses, purulent leaks and thrombovasculitis.
A feature of streptococcal infection is also the lymphogenous path of progression with the development of lymphatic drainage disorders, severe tissue swelling and frequent necrotizing lymphadenitis.
The pathomorphology of Pseudomonas aeruginosa infection is determined by the absence of necrotizing exotoxin and hyaluronidase in the pathogen, the significant strength of endotoxin and the activity of putrefactive enzymes. With this infection, black areas naturally appear in the wound due to the putrefactive decomposition of necrotic tissues, and in the tissues adjacent to the foci of reproduction (and death) of microorganisms, under the influence of diffusing endotoxin, inflammation develops, characterized by severe circulatory disorders in the form of severe plethora, hemorrhages and abundant exudation of fibrin with a small number of leukocytes in the exudate.
Purulent surgical complications, depending on the extent of the process, clinical manifestations and severity, are divided into two groups:
- local:
- acute purulent pericarditis;
- heart abscess;
- wound suppuration;
- acute purulent mediastinitis;
- empyema of the pleura.
- are common:
- pneumonia;
- sepsis.
Pericarditis
Pericarditis is one of the most common cardiac surgical complications. Postoperative pericarditis is a severe, but almost inevitable, complication of cardiac surgery, but the degree of its severity very much depends on the characteristics of the surgical intervention (duration, traumaticity, etc.).
A highly informative non-invasive method for diagnosing pericarditis is echocardiography, which allows not only to detect the presence of effusion in the pericardial cavity, but also to analyze the nature of the location of the epi- and pericardium in various parts of the heart.
V. B. Pyryev et al. (1994) showed that with a small volume of fluid in the pericardial cavity, the echo-free space, as a rule, is noted only in the region of the posterior wall of the left ventricle. With pronounced accumulation of fluid (more than 250 ml), the echo-free space is recorded in both the posterior and anterior parts of the pericardial sac.
Postoperative cardiac abscesses
Postoperative cardiac abscesses are prognostically unfavorable complications of cardiac surgery and blood transfusion operations.
According to Yu. L. Shevchenko and S. A. Matveev (1996) and others, postoperative cardiac abscesses can occur as complications:
- closed heart surgery (closed mitral and tricuspid commissurotomy, correction of certain forms of congenital heart defects);
- operations in conditions of extracorporeal circulation (heart valve replacement, correction of congenital and post-traumatic heart defects, coronary artery and mammary coronary bypass surgery, removal of foreign bodies and heart transplantation);
blood transfusion operations (hemodialysis, hemosorption, hemapheresis, extracorporeal hemoxygenation, intravascular laser and ultraviolet irradiation of blood).
Mediastinitis
One of the life-threatening complications after heart surgery is mediastinitis. . Although the frequency of its occurrence is not so high - 0.3 - 6%, the mortality rate is up to 70% (Akchurin R. S. et al., 1992; Ostrovsky Yu. P. et al. , 1996).
Mediastinitis after cardiac surgery occurs in the form of acute inflammation of the anterior mediastinum. General clinical symptoms of acute infectious inflammation in the anterior mediastinum usually begin to appear only from the 7th to 10th day. after operation. It is known that after surgery on the anterior mediastinum and the pericardial cavity, they contain residual air, which subsequently resolves. When an inflammatory process occurs, residual air and accumulating exudate prevent the reduction of the wound cavity of the anterior mediastinum. The shadow of the moving fluid level is quite well identified during chest X-ray (Makarov A. A., Perets V. I., 1994).
Pneumonia
Pneumonia in cardiac surgery patients is one of the important, thanatogenetically significant complications. In its occurrence, many reasons are important, both endogenous (for example, immunodeficiencies or the presence of foci of chronic inflammation against the background of chronic venous congestion of the lungs) and exogenous (for example, hospital infection, including transmitted through ventilators, as well as during repeated surgical interventions ).
Example. Patient R., 37 years old, who suffered from rheumatism in the form of combined defects of the mitral (stenosis), tricuspid (insufficiency) and aortic (insufficiency) valves since the age of 7, underwent a closed mitral commissurotomy with a short-lived positive effect. After 5 years, the mitral valve was replaced with a disc-shaped prosthesis, as well as annuloplication of the tricuspid valve under extracorporeal circulation. The postoperative period is complicated by the cutting through of part of the sutures of the mitral valve with the formation of a paravalvular fistula, which was diagnosed using ultrasound. Probing of the heart chambers revealed grade III mitral valve insufficiency and grade II aortic valve insufficiency. After 2 weeks, the patient, for health reasons, underwent suturing of the paravalvular fistula and plastic surgery of the aortic valve under EKC conditions. During the operation, it was discovered that in addition to the cutting of the mitral valve sutures, there were 2 semilunar defects with smooth edges on the aortic valve flaps - 6 in total. These defects were sutured with U-shaped and continuous sutures. The diameter of the aortic opening was 1.5 - 2 cm. The postoperative period was complicated by coagulopathic bleeding from dissected adhesions with the formation of right-sided hemothorax. In 1 day. A rethoracotomy was performed with revision and bleeding control. In the postoperative period there were signs of respiratory failure, and therefore on the 2nd day. After reoperation, a tracheostomy was performed and mechanical ventilation through the tracheostomy was continued. Auscultation - a lot of fine rales over both lungs. X-ray revealed a bilateral decrease in pulmonary pneumatization, and a moderate amount of fluid in the pleural cavities. The liver is palpated at the level of the navel. Spontaneous breathing is ineffective, tachypnea immediately occurs, then bradypnea with increasing cyanosis and the appearance of a grayish tint to the face. A small amount of hemorrhagic sputum is aspirated from the trachea. Bigeminy was noted. After 5 days. after the tracheostomy was applied, the nature of the sputum changed - purulent sputum began to be evacuated, and auscultation in the lungs in large quantities - fine bubble moist rales. Hyperthermia appeared - up to 38.3 °C, as well as a hyperosmolar state (325 mOsmol x l -1), caused mainly by hypernatremia (158 mmol x l -1). Over the next 4 days. , despite active antibacterial therapy against the background of ongoing mechanical ventilation, the phenomena of bilateral pneumonia increased. Then a collapsetoid decrease in blood pressure occurred to 60/20 mm Hg. Art. , a sharp increase in central venous pressure to 23 cm of water. Art. Intensive therapy with the use of dexazone, dopmin and other cardiac stimulating drugs had little temporary effect. 3 hours later - cardiac arrest. Resuscitation measures were unsuccessful for 40 minutes.
Acute pulmonary failure or pulmonary edema is a serious disruption of gas exchange in organs as a result of transudate entering the lung tissue from the capillaries. That is, the liquid enters the lungs. Pulmonary edema is a pathological condition accompanied by an acute deficiency of oxygen throughout the body.
There are different forms of edema depending on the reasons for the development of the disease and the time of its development.
Types by speed of development
- Acute development. The disease manifests itself within 2-3 hours.
- Prolonged swelling. The disease lasts a long time, sometimes a day or more.
- Lightning current. It comes completely suddenly. The lethal outcome, as an inevitability, occurs within a few minutes.
There are a number of classic underlying causes of pulmonary edema.
Thus, non-cardiogenic edema is caused by various causes not related to cardiac activity. These could be kidney diseases, toxin poisoning, injuries.
Cardiogenic edema is caused by heart disease. Typically, this type of disease occurs against the background of myocardium, arrhythmia, heart defects, and circulatory disorders.
Predisposing factors
- Sepsis. Toxins then enter the bloodstream.
- based on various types of infections or injuries.
- Exceeding doses of certain medications.
- Radiation damage to organs.
- Drug overdose.
- Any heart disease, especially during its exacerbation.
- Frequent attacks.
- Pulmonary diseases, for example, bronchial asthma, emphysema.
- Thrombophlebitis and varicose veins, accompanied by thromboembolism.
- Low levels of protein in the blood, which manifests itself in cirrhosis of the liver or other pathologies of the liver and kidneys.
- A sharp change in air pressure when rising to a high altitude.
- Exacerbation of hemorrhagic pancreatitis.
- Entry of a foreign body into the respiratory tract.
All these factors together or one at a time can be a strong impetus for the occurrence of pulmonary edema. If these diseases or conditions occur, it is necessary to monitor the patient's health status. Monitor his breathing and general vital activity.
From the proposed video, find out how we harm our lungs.
Diagnostics
To take the necessary first resuscitation measures and to treat the patient, a correct diagnosis of the disease is required.
During a visual examination during an attack of suffocation and pulmonary edema, it is necessary to pay attention to the patient’s appearance and the position of his body.
During an attack, excitement and fear are clearly evident. And noisy breathing with wheezing and whistling can be clearly heard from a distance.
During the examination, pronounced or bradycardia is observed, and the heart is difficult to hear due to bubbling breathing.
In addition to a routine examination, an ECG and pulse oximetry are often performed. Based on these examination methods, the doctor makes a diagnosis.
In case of pulmonary edema, an electrocardiogram shows a rhythm disturbance. And with the method of determining blood oxygen saturation, a sharp decrease in oxygen levels is highlighted.
Pulmonary edema: treatment
Treatment of a patient with pulmonary edema is carried out in a hospital setting in the intensive care unit. Treatment largely depends on the condition of the patient and his individual characteristics of the body.
Principles of treatment
- Decreased respiratory excitability
- Increased contractions of the heart muscle
- Unloading blood circulation in a small circle
- Saturation of blood with oxygen - oxygen therapy - from a mixture of oxygen and alcohol
- Calming the nervous system using sedatives
- Eliminating fluid from the lungs using diuretics
- Treatment of the underlying disease
- Use of antibiotics in case of secondary infection
- The use of drugs that improve heart function
In hospital treatment, the following drugs are used:
- Narcotic analgesics and neuroleptics, for example, Morphine, Fentanyl in small doses, intravenously.
- Diuretics, for example, Lasix, Furosemide.
- Cardiotonic glycosides, for example, Strophanthin, Korglykon.
- Bronchial antispasmodics: Euphylline, Aminophylline.
- Hormonal drugs - glucocorticoids, for example Prednisolone intravenously.
- Broad-spectrum antibiotic drugs. The most popular uses are Ciprofloxatin and Imipenem.
- When the level of protein in the blood is low, plasma from donor blood is used as an infusion.
- If the swelling is caused by thromboembolism, it must be used intravenously.
- To lower blood pressure, use Dobutamine or Dopamine.
- For low heart rate, Atropine is used.
All doses and quantities of drugs for different purposes are prescribed to the patient individually. It all depends on the age of the patient and the specifics of the disease, on the state of the patient’s immunity. These medications should not be used before a medical prescription, as this will worsen the situation.
After the attack has been relieved and breathing functions have been restored, treatment may be used. Their use can be started after consultation with a doctor unless prohibited.
An effective method in this treatment is the use of decoctions, infusions and teas that have an expectorant effect. This is what will help remove serous fluid from the body.
During treatment, it is imperative to direct actions to improve not only the physical and physiological condition of the patient. It is necessary to bring a person out of a stressful state by improving his emotional state.
Any treatment during pulmonary edema should be carried out under the strict supervision of the attending physician. During the first period of therapy, all drugs are administered intravenously, since it is very difficult to take drugs orally.
Providing emergency assistance
There are a number of urgent measures to provide first aid to a person with pulmonary edema. The absence of such assistance can worsen the patient's condition.
Preventing oxygen starvation is the primary task of doctors. Otherwise, the consequences of the attack will be irreversible.
The coordinated work of emergency workers and the correct actions of loved ones will help avoid serious complications and consequences after an attack of respiratory failure.
Pulmonary edema: prognosis
It must be understood that the prognosis after suffering pulmonary edema is rarely favorable. Survival rate, as already mentioned, is no more than 50%.
However, many people experience some deviations after treatment. If pulmonary edema occurs against the background of myocardial infarction, then the mortality rate exceeds 90%.
In case of survival, it is necessary to be observed by doctors for more than a year. It is imperative to use an effective one to cure the underlying disease that caused the pulmonary edema.
If the root cause is not eliminated, then there is a 100% chance of relapse.
Any therapy is aimed at relieving swelling and preventing its recurrence.
Only correct and timely treatment measures can give a favorable prognosis. Early pathogenetic therapy at the initial stage, timely detection of the underlying disease, and proper treatment will help give a favorable prognosis for the outcome of the disease.
Prevention of pulmonary edema
Preventive measures in the fight against pulmonary edema are timely treatment of diseases that cause edema. Eliminating the causes is prevention.
A healthy lifestyle, compliance with safety rules when working with harmful substances, poisons and toxins, compliance with the dosage of medications, absence of drug abuse and overeating - all these are preventive measures that will help avoid attacks of pulmonary failure.
If you have chronic diseases or hypertension, you should follow all doctor’s instructions in good faith.
An additional preventative measure is management, proper nutrition and an active lifestyle.
It is impossible to reliably exclude the moment of an attack, since it is impossible to provide guaranteed insurance against infection or injury, but you can reduce the risk of its occurrence. It should be remembered that timely assistance for pulmonary edema is a life saved.6