ICU · Respiratory / ventilation
Pulmonary Oedema — Cardiogenic vs ARDS
Also known as Pulmonary oedema · Cardiogenic pulmonary oedema · Non-cardiogenic pulmonary oedema · ARDS vs cardiogenic · PAWP · Pulmonary artery wedge pressure · BNP · CPAP for pulmonary oedema · 3CPO trial · Bat-wing infiltrates
Pulmonary oedema is fluid in the alveoli from one of two mechanisms: cardiogenic (hydrostatic — raised pulmonary capillary pressure from left-heart failure) or non-cardiogenic (increased permeability — ARDS, a damaged alveolar-capillary membrane, wedge pressure not raised). The distinction is made on the PAWP, the BNP, the echocardiogram, and the CXR pattern. Cardiogenic oedema is treated with CPAP/NIV, diuretics, and vasodilators; ARDS is treated with lung-protective ventilation, PEEP, proning, and a conservative fluid strategy. The oedema-fluid-to-serum protein ratio distinguishes them at the bedside (mean 0.37–0.46 in cardiogenic series versus 0.84 in permeability oedema — a ratio over 0.6 suggests increased permeability).
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Overview & definition
Pulmonary oedema is fluid in the alveoli from one of two mechanisms, and the distinction is the entire exam question.[2]
- Cardiogenic (hydrostatic) — left-heart pressure rises (LV failure, mitral valve disease, volume overload) and pushes a low-protein transudate out of the capillaries into the alveoli, despite an intact alveolar–capillary membrane. The pulmonary artery wedge pressure is raised.[2]
- Non-cardiogenic (increased permeability — ARDS) — the alveolar–capillary membrane is damaged (sepsis, pneumonia, aspiration, trauma) and a protein-rich exudate leaks into the alveoli, despite a normal or low wedge pressure.[2]
The distinction drives the treatment — cardiogenic oedema responds to diuresis and CPAP; ARDS does not, and needs lung-protective ventilation, PEEP, and a conservative fluid strategy.[2]
References17ShowHide
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- [14]Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome N Engl J Med, 2015.PMID 25693014
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