Pulmonary oedema or pulmonary congestion is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extravascular compartments of the lung.

Common cause of pulmonary oedema are cardiac/fluid overload, and the common causes are;

• Systolic heart failure complicating fluid overload

• Renal failure complicating fluid overload

• Iatrogenic fluid overload

  
  

Other Cause of pulmonary oedema

Increased capillary permeability Acute Respiratory Distress Syndrome (ARDS); many causes include;

Systemic sepsis–gram negative infection, pancreatitis, head injury, aspiration of gastric contents, amniotic embolus.

Pharmacological

Cardiac failure

• Furosemide 20mg–80mg IV, may be repeated in 10–15 minutes

• If symptoms persist, morphine 1–3mg IV diluted form,

• Inotropic support if hypotensive SBP < 90mmHg–dobutamine 2–20 μg/kg/min

• Intravenous vasodilator nitroglyceride if SBP > 100mmHg.

  
  

Non–cardiac (ARDS)

• Treat the underlying conditions

• Ventilate with PEEP – if RF

• Inotropic support if SBP<90mmHg

• Dialysis if renal fail

  
  

Referral

All patients suspected pulmonary oedema should be referred to high level of care where hospital resourced with high care dependent unit or intensive care unit hospital. Patient should be stabilized first at low level of care before referral to the high level of care

Non-pharmacological

Initial management

• Maintain airway, bed rest in Fowler`s position except if hypotensive or comatose

• Administer oxygen to keep PO2 > 60 mmHg (O2 saturation > 90%)

• Correct base–acid & electrolyte disorders, determine and correct arrhythmias,