Beneficial Effects of Reducing Pulmonary Edema in Patients with Acute Hypoxemic Respiratory Failure

Abstract

In patients with acute hypoxemic respiratory failure (AHRF), the airspace is flooded from leaky pulmonary vessels and alveolar membranes, which causes blocking of oxygen transfer from the airspaces into the blood. 1 Rinaldo JE Rogers RM. Adult respiratory distress syndrome: changing concepts of lung injury and repair.. N Engl J Med. 1982; 306: 900-908 Crossref PubMed Scopus (372) Google Scholar , 2 Hall JB Wood LDH. Pulmonary edema.. in: Cherniack R Current therapy in respiratory medicine. BC Dekker, Toronto1986: 222-227 Google Scholar , 3 Prewitt RM McCarthy J Wood LDH. Treatment of acute low pressure pulmonary edema in dogs: relative effects of hydrostatic and oncotic pressure, nitroprusside and PEEP.. J Clin Invest. 1981; 67: 409-419 Crossref PubMed Scopus (140) Google Scholar , 4 Sznajder JI Zucker A Wood LDH Long GR. The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema.. Am Rev Respir Dis. 1986; 34: 222-228 Google Scholar This sequence of events results in hypoxemia, reduced oxygen delivery, hypercapnia, and death if corrective therapy is not applied. Although patients with AHRF die most often of multiple organ failure complications, 5 Montgomery AB Stager MA Carrico CJ et al. Causes of mortality in patients with the adult respiratory distress syndrome.. Am Rev Respir Dis. 1985; 132: 485-489 PubMed Google Scholar several reports support the notion that strategies to actively reduce pulmonary edema reduce the length of stay of these patients in the intensive care unit (ICU) and are associated with reduced mortality. 6 Simmons RS Berdine GG Seidenfeld JJ Prihoda TJ Harris GD Smith JD et al. Fluid balance and the adult respiratory distress syndrome.. Am Rev Respir Dis. 1987; 135: 924-929 Crossref PubMed Scopus (216) Google Scholar , 7 Eisenberg PR Hansbrough JR Anderson D Schuster DP. A prospective study of lung water measurements during patient management in an intensive care unit.. Am Rev Respir Dis. 1987; 136: 662-668 Crossref PubMed Scopus (153) Google Scholar , 8 Humphrey HJ Hall J Sznajder JI Silverstein M Wood LDH. Improved survival following pulmonary capillary wedge pressure reduction in patients with ARDS.. Chest. 1990; 97: 1176-1180 Abstract Full Text Full Text PDF PubMed Scopus (235) Google Scholar Compelling evidence shows that pulmonary vascular leakage is reduced by lowering the pulmonary vascular pressure. This has been shown to improve alveolar gas exchange in animal models of acute lung injury. 3 Prewitt RM McCarthy J Wood LDH. Treatment of acute low pressure pulmonary edema in dogs: relative effects of hydrostatic and oncotic pressure, nitroprusside and PEEP.. J Clin Invest. 1981; 67: 409-419 Crossref PubMed Scopus (140) Google Scholar 4 Sznajder JI Zucker A Wood LDH Long GR. The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema.. Am Rev Respir Dis. 1986; 34: 222-228 Google Scholar 9 Zucker AR Wood LDH Curet-Scott M Crawford GP Sznajder JI. Partial lung bypass reduces pulmonary edema induced by kerosene aspiration in dogs.. J Crit Care. 1991; 6: 29-35 Abstract Full Text PDF Scopus (1) Google Scholar One clinical study reported no relationship between edema and mortality in AHRF. 10 Brigham KL Kariman K Harris TR Snapper JR Bernard GR Young SL. Correlation of oxygenation with vascular permeability-surface area but not with lung water in humans with acute respiratory failure and pulmonary edema.. J Clin Invest. 1983; 72: 339-349 Crossref PubMed Scopus (56) Google Scholar Yet this study did not evaluate the effects of an intervention on edema or mortality; rather, it described the associations, or lack thereof, across a population of patients with AHRF.