What is non-cardiogenic pulmonary edema?

From the Guidelines

Non-cardiogenic pulmonary edema should be managed with oxygen therapy and mechanical ventilation using low tidal volumes and positive end-expiratory pressure (PEEP), as outlined in the Berlin definition for acute respiratory distress syndrome (ARDS) 1.

Key Considerations

• The Berlin definition for ARDS, as shown in Table 6 of the study 1, provides a framework for diagnosing and managing non-cardiogenic pulmonary edema, with criteria including onset time, hypoxemia, causes of pulmonary edema, and abnormality in imaging.
• Oxygen therapy should be initiated immediately to maintain oxygen saturation above 93%, with the option to escalate to high-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) if necessary, as described in the study 1.
• Mechanical ventilation with low tidal volumes (4-6 ml/kg) and appropriate PEEP should be implemented in severe cases, with consideration of invasive mechanical ventilation if HFNO or NIV is insufficient, as recommended in the study 1.
• Specific treatments depend on the underlying cause of non-cardiogenic pulmonary edema, such as naloxone for opioid overdose or rapid descent for high-altitude pulmonary edema.

Management Strategies

• HFNO may be considered for patients who require high levels of oxygen therapy, with initial settings of 30-40 L/min and oxygen concentration 50%-60%, as described in the study 1.
• NIV may be useful in reducing respiratory power consumption and improving oxygenation, but should be used with caution in patients with hemodynamic instability or multiple organ failure, as noted in the study 1.
• Invasive mechanical ventilation should be implemented as soon as possible if ARDS persists or worsens despite HFNO or NIV, with a strategy of protective lung ventilation using lower tidal volumes and plateau pressures, as recommended in the study 1.
• Extracorporeal life support (ECLS) may be considered in severe cases of refractory hypoxemia, but should only be carried out in professional centers with access to expertise, as suggested in the study 1.

From the Research

Definition and Causes of Non-Cardiogenic Pulmonary Edema

• Non-cardiogenic pulmonary edema is defined as pulmonary edema not caused by an increase in left ventricular filling pressure and elevated pulmonary capillary pressure 2.
• It can be caused by various factors, including sepsis, which is the most frequent predisposing disease 2.
• Other causes can include acute respiratory distress syndrome (ARDS), which is characterized by the rapid onset of non-cardiogenic pulmonary edema resulting in respiratory failure and hypoxemia 3.

Clinical Presentation and Treatment

• Non-cardiogenic pulmonary edema can present with severe respiratory failure, hemodynamic instability, and a huge amount of sputum 4.
• Treatment options include mechanical ventilation, high-dose corticosteroids, hemodialysis with ultrafiltration, and hemofiltration 2.
• In severe cases, venovenous extracorporeal membrane oxygenation (VV-ECMO) and aggressive fluid replacement may be necessary 4.
• Lung-protective ventilation is also a key component of treatment, particularly in cases of ARDS 3.

Prognosis and Mortality

• The mortality rate for non-cardiogenic pulmonary edema can be high, reaching up to 69% in some cases 2.
• Additional organ failure can increase mortality, while patients without complications tend to have a better prognosis 2.
• Prompt treatment and aggressive management can improve clinical outcomes, even in severe cases 4.