Prospective analytical study on acute pulmonary edema in obstetric intensive care unit

Background: Acute pulmonary oedema is an uncommon,but life threatening event in pregnancy. It causes significant morbidity and mortality due to pathophysiology of pre‐eclampsia and physiological changes of pregnancy which may aggravate certain pre-existing heart disease.Methods: This study was conducted to describe the clinical and epidemiological profile of antenatal women with acute pulmonary edema in obstetric ICU from January 2017 to December 2018 (2 years) in Mahathma Gandhi Memorial Government Hospital, Trichy, Tamil Nadu, India.Results: Acute pulmonary edema (n=31) accounts for 2.7% of ICU/HDU admissions in the study period. Most common etiology observed was severe preeclampsia (12 cases) followed by cardiogenic pulmonary edema (11 cases). Fluid overload, sepsis accounted for 7 cases and one mother with preexisting RHD had severe pre-eclampsia with acute pulmonary edema.Conclusions: Hypertensive disorders of pregnancy and heart disease contributes to major proportion of acute pulmonary edema in this study and it is imperative to recognize signs of critical illness. Skilled multidisciplinary teamwork plays an important role in optimizing maternal and fetal health.

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Gagal Napas Akut dengan Hipoksemia Refrakter pada Preeklampsi Berat Aplikasi “PEEP Tinggi dan Balans Cairan Negatif” di ICU

Green Medical Journal ◽

10.33096/gmj.v1i1.16 ◽

2019 ◽

Vol 1 (1) ◽

pp. 15-34

Author(s):

Faisal Sommeng

Keyword(s):

Mechanical Ventilation ◽

Pulmonary Edema ◽

Day Care ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Acute Pulmonary Edema ◽

High Peep ◽

Refractory Hypoxemia ◽

Life Threatening ◽

Life Threatening Event

Introduction: Acute pulmonary edema in pregnancy due to preeclampsia is a life-threatening event and a form of maternal morbidity. The hypoxemia is clinical manifestation feature. Refractory hypoxemia is an increasing in the partial pressure of oxygen in the arteries (PaO2) <5 mmHg with a 10% increase in FiO2 or PaO2 <60 mmHg or P/F ratio <100 on FiO2 80-100% with PEEP> 10-20 cmH20 at more than 12- 24 hours. In this case, a 35-year-old female patient entered to the ICU Wahidin Sudirohusodo General Hospital from the emergency room operating teater with acute pulmonary edema ec PEB + Post Sectio cesarian, mechanical ventilation (VM) PCV+ Pins 20 mode, PEEP 10, PS 15, RR 20, Vt 350 – 400 ml, FiO2 100% was performed and maximum SpO2 produced only up to 96%, P/F ratio 95,2. After 11 hours of mechanical ventilation, blood gas analysis obtained pH 7.52, PaCO2 28.5, sat 89.6%, PaO2 50.1 HCO3 23.2 BE 2.2 P/F ratio 62 with 100% FiO2 and airway pressure 30 cmH2O and was diagnose refractory hypoxemic. Therapy: Sedation, administration of muscle relaxants, changes in high PEEP ventilator settings and fluid evacuation. setting high PEEP up to 25 cmH2O by increasing the A / W pressure every 2 minutes periodically until 55 cmH2O hold for 2 minutes and setting ventilator PCV: Pinsp 20, PEEP 15-20, FiO2 80%. and fluid evacuation with diuretics is carried out. Results: Improvement of P / F ratio up to 139 at the time of recruitment maneuver and P / F ratio improved up to 244 after 6 hours of the maneuver. the patient was weaning from the ventilator at 5th day care with P / F ratio 313 and tranfer to ward care on the 6th day care.

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Open Lung Recruitment untuk Pasien Udem Paru Akut Pasca Operasi Sesar

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v3i1.39 ◽

2020 ◽

Vol 3 (1) ◽

pp. 9-19

Author(s):

Dwiana Sulistyanti ◽

Yusmein Uyun

Keyword(s):

Pulmonary Edema ◽

Pregnant Women ◽

Good Condition ◽

Rare Event ◽

Lung Recruitment ◽

Acute Pulmonary Edema ◽

Open Lung ◽

Increased Risk ◽

Life Threatening ◽

Severe Infections

Udem paru akut pada wanita hamil merupakan kejadian yang jarang tetapi merupakan kejadian yang dapat mengancam jiwa. Meskipun merupakan kejadian yang jarang terjadi tetapi berhubungan dengan meningkatnya resiko pada ibu juga meningkatkan morbiditas dan mortalitas janin. Beberapa faktor resiko yang diidentifikasikan dapat menyebabkan udem paru: preeklamsi atau eklamsi, infeksi yang berat, penggunaan obat tokolitik, kelebihan cairan dan kehamilan ganda. Selain itu, perubahan fisiologi yang berhubungan dengan kehamilan mungkin bisa menjadi penyebab udem paru pada wanita hamil. Ventilasi mekanik efektif meningkatkan kandungan oksigen dan menurunkan trauma pada paru. Open lung recruitment dapat meningkatkan oksigenasi pada pasien dengan udem paru akut, dapat menurunkan indeks cairan ekstravaskuler paru, meningkatkan pengembangan paru dan menurunkan tekanan pada jalan nafas. Laporan kasus ini menjelaskan tentang penanganan udem paru akut pada wanita muda pasca operasi sesar atas indikasi preeklamsi, dimana dilakukan open lung recruitment saat pasien dirawat di ruang ICU, pasien dirawat selama hampir 2 minggu dan pulang dalam keadaan baik. Open Lung Recruitment for Patient Acute Pulmonary Edema Post Caesarean Section Abstract Acute pulmonary edema in pregnant women is a rare but life-threatening event. Although it is a rare event, but it is associated with an increased risk for the mother as well as increasinh fetal morbidity and mortality. Several indentified risk factors can cause pulmonary edema : preeclampsia or eclamsia, severe infections, use of tocolytic drugs, fluid overload, and multiple pregnancies. In adition, physiological changes related to pregnancy may be a cause of pulmonary edema in pregnant women. Mechanical ventilation effectively increases oxygen content and reduces trauma to the lungs. Open lung recruitment can increase oxygenation in patient with acute pulmonary edema, can reduce the pulmonary extravascular fluid index, increase lung development, and reduce pressure on the airway. This case report describes the management of acute pulmonary edema in young women post-operative cesarean section for indications of preeclampsia, where open lung recruitment is performed when the patient is treatedin the ICU, the patient is treated for almost two weeks and return home in good condition.

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Pickering syndrome: a rare presentation in emergency department

BMJ Case Reports ◽

10.1136/bcr-2020-239421 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239421

Author(s):

Prawal Shrimal ◽

Ankit Kumar Sahu ◽

Roshan Mathew ◽

Abhinav Bansal

Keyword(s):

Emergency Department ◽

Renal Artery ◽

Pulmonary Edema ◽

Young Patient ◽

Renal Artery Stenosis ◽

Early Recognition ◽

Hypertensive Emergency ◽

Acute Pulmonary Edema ◽

Rare Presentation ◽

Life Threatening

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.

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A Scombroid Poisoning Causing a Life-Threatening Acute Pulmonary Edema and Coronary Syndrome in a Young Healthy Patient

Cardiovascular Toxicology ◽

10.1007/s12012-011-9115-1 ◽

2011 ◽

Vol 11 (3) ◽

pp. 280-283 ◽

Cited By ~ 22

Author(s):

Antonio D’Aloia ◽

Enrico Vizzardi ◽

Paolo Della Pina ◽

Silvia Bugatti ◽

Francesca Del Magro ◽

...

Keyword(s):

Pulmonary Edema ◽

Acute Pulmonary Edema ◽

Healthy Patient ◽

Coronary Syndrome ◽

Life Threatening

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Might life-threatening acute pulmonary edema occur after using recombinant tissue plasminogen activator? A case report

BMC Neurology ◽

10.1186/s12883-021-02371-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xue-Bing Chen ◽

Dong Qu ◽

Qing Zhang ◽

Xia Yue ◽

Dong-Fang Qiao

Keyword(s):

Ischemic Stroke ◽

Pulmonary Edema ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Vital Signs ◽

Recombinant Tissue Plasminogen Activator ◽

Acute Pulmonary Edema ◽

Tissue Plasminogen ◽

Life Threatening

Abstract Background Recombinant tissue plasminogen activator (rt-pa) is the first-line drug for the treatment of acute ischemic stroke, and can lead to some complications.There were rare reports of death due to acute pulmonary edema during rt-pa thrombolysis treatment. Case presentation This study reports a 30-year-old man was diagnosed with acute ischemic stroke and underwent rt-pa thrombolytic therapy. Finally he died despite active rescue. Conclusions The autopsy revealed that he died of acute pulmonary edema. This case suggests that it is necessary to pay close attention to the changes of vital signs during thrombolysis and be aware of possibility of pulmonary edema during thrombolysis.

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Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

Case Reports in Medicine ◽

10.1155/2013/904952 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Andrea Fisicaro ◽

Massimo Slavich ◽

Eustachio Agricola ◽

Claudia Marini ◽

Alberto Margonato

Keyword(s):

Mitral Valve ◽

Pulmonary Edema ◽

Clinical Presentation ◽

Surgical Intervention ◽

Cardiovascular Complications ◽

Atrial Myxoma ◽

Acute Pulmonary Edema ◽

Mitral Valve Stenosis ◽

Primary Cardiac Tumor ◽

Life Threatening

Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.

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