OVERVIEW
Overview
Retractile pulmonary edema is an acute pulmonary edema that occurs in the affected lung or both lungs within a short period of time (minutes to hours) during the process of relieving the compression on the lungs so that the atrophied lungs can be retracted, with a case fatality rate of about 20%.
Whether medical insurance
Yes, it is
Department of Medicine
Department of Respiratory Medicine, Department of Thoracic Surgery.
Clinical symptoms
Sudden cough, dyspnea, telangiectasia, coughing up white or pink foamy sputum, ashen face, pinched lips and limbs, profuse sweating, irritability, palpitations, and fatigue.
Hazards
Leads to hypoxemia, respiratory failure, shock, and even multiple organ failure leading to death.
Complications
Disseminated intravascular coagulation (DIC), acid-base imbalance, shock, etc.
Examination
Electrocardiogram, arterial blood gas analysis, X-ray film, etc.
Diagnosis
In combination with a history of operations to relieve lung compression, such as closed chest drainage or tumor resection, the patient develops sudden cough, dyspnea, foamy sputum within a short period of time (minutes to hours) after the operation, with wet rales throughout the affected lungs, chest X-ray showing the affected lungs reopened with patchy infiltration, and hypoxemia.
Principles of treatment
Prevention is important. The principles of treatment are: (1) Keep the airway open. (2) Oxygenation and respiratory support therapy. (3) Maintain blood volume. (4) Apply adrenocorticotropic hormone, diuretics, cardiotonic agents and other drugs, and correct the water electrolyte and acid-base imbalance; (5) control the fluid intake.
Curability
The case fatality rate is about 20%. It lies in the rate at which the patient develops recurrent pulmonary edema and its severity.
Dietary recommendations
Eat foods high in sugar as much as possible, restructuring to the first carbohydrate, the second fat-proof, the third protein, and more liquid energy intake if possible, such as juices, broths, and milk, and also replenish some of the water.
Important reminders
Closed chest drainage operation should be carried out in the process of strict control of the daily drainage volume as well as the drainage rate, to avoid drainage too fast or drainage volume is too large.
Causes
Epidemiology
The mortality rate is about 20%.
Etiology
In pneumothorax, pleural effusion, huge tumor in the thoracic cavity and other causes of lung atrophy on the diseased side, through the closed thoracic drainage or tumor resection, to relieve the pressure on the lung, so that the atrophied lung can be reopened process, the lung reopening caused by too fast.
Transmission
Non-infectious.
Symptoms and Diagnosis
Typical symptoms
Sudden cough, dyspnea, sedentary breathing, coughing up white or pink foamy sputum, grayish face, pinched lips and limbs, profuse sweating, irritability, palpitation, weakness, etc.. A lot of wet rales can be heard in both lungs.
Diagnostic basis
The diagnosis can be made on the basis of the patient’s history of operations to relieve lung compression, such as closed chest drainage or tumor resection, sudden cough, dyspnea, frothy sputum within a short period of time (minutes to hours) after the operation, wet rales throughout the affected lungs, chest X-ray showing the affected lungs reopened with patchy infiltration shadows, and hypoxemia.
Treatment
Treatment guideline
1. The patient should try to take a semi-sitting position, with legs hanging down as far as possible, in order to reduce the volume of return blood and alleviate pulmonary stasis. 2. Keep the airway open, give oxygen and respiratory support therapy, which can be corrected after oxygen inhalation in mild hypoxemia, and when oxygen is given by nasal catheter and mask, the concentration of oxygen inhalation should be ≥50%, and at the same time, add expectorant agent, e.g., 50% alcohol. 3. If the condition is more serious and tracheal intubation and tracheotomy have been performed, positive end-expiratory pressure mechanical ventilation is used to maintain alveolar opening, reduce excessive alveolar surface tension due to insufficient alveolar surface-active substances, improve the imbalance of the ventilation/blood flow ratio, and reduce intrapulmonary shunting, reduce pulmonary capillary transmembrane pressure and leakage of blood components, and increase the partial pressure of oxygen to a clinically acceptable level.3, control the amount of fluid intake. Monitor central venous pressure (CVP) and effectively control the volume and rate of fluid infusion.4. Apply adrenocorticotropic hormone to increase the stability of pulmonary capillary membranes, as well as diuretics (furosemide, dihydroketorolac tiazide), cardiac tonicity (furfurazepoxide propionate), aminophylline, and other medications, and correct the water-electrolyte and acid-base imbalances.
Drug treatment
Apply adrenocorticotropic hormone to increase the stability of pulmonary capillary membrane, and apply diuretics (furosemide, dihydroclonidine), cardiotonic (furfuracein propyl), aminophylline and other drugs, and correct the water electrolyte and acid-base imbalance.
Prognosis
The case fatality rate is about 20%. It depends on how quickly the patient develops recurrent pulmonary edema and how severe it is.
Nursing care
Daily care
Patients with closed chest drainage should pay close attention to the drainage speed and flow rate of the patient to avoid excessive drainage speed and flow rate.
Dietary management
Eat foods high in sugar as much as possible, restructuring to the first carbohydrate, the second fat-proof, the third protein, with more liquid energy intake if possible, such as juice, broth, milk, and also replenish part of the water.