Besides history and clinical examination, what investigations may help distinguish between cardiac and non-cardiac causes of pulmonary oedema in the critically ill patient?
1) Measurement of PCWP and CI
2) Serum BNP
3) Echocardiography
4) PICCO
Echocardiography is a straightforward answer, as is BNP.
PCWP and cardiac index are indirectly related to this answer- one can cave a patient with a noncardiogenic pulmonary oedama as well as a poor cardiac index; the inference that the oedema has occurred because of the poor cardiac index would be incorrect.
The PICCO is even more obscure. Yes, it gives to you the extravascular lung water, but this only tells you that there is water in the lungs (which you already knew).
However, some authors have asserted that thermodilution measurements of pulmonary permeability can differentiate pulmonary oedema from ARDS.
Cardiogenic | Non-cardiogenic |
Excessive LV afterload
Excessive LV preload
Excessive left atrial afterload
Poor contractility
Ineffective contractility
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Increased capillary permeability
Neurogenic pulmonary oedema
Drug-induced pulmonary oedema
Raised pulmonary arterial pressure
Negative pressure pulmonary oedema
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Investigation | Cardiogenic pulmonary oedema | Non-cardiogenic pulmonary oedema |
History |
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Examination |
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ECG findings |
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Troponin |
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Brain natriuretic peptide (BNP) |
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Chest Xray |
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Echocardiography |
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Swan-Ganz catheter |
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Karmpaliotis, Dimitri, et al. "Diagnostic and prognostic utility of brain natriuretic Peptide in subjects admitted to the ICU with hypoxic respiratory failure due to noncardiogenic and cardiogenic pulmonary edema." CHEST Journal 131.4 (2007): 964-971.
Monnet, Xavier, et al. "Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS." Intensive care medicine 33.3 (2007): 448-453.
Ware, Lorraine B., and Michael A. Matthay. "Acute pulmonary edema." New England Journal of Medicine 353.26 (2005): 2788-2796.
Gluecker, Thomas, et al. "Clinical and radiologic features of pulmonary edema." Radiographics 19.6 (1999): 1507-1531.
Karmpaliotis, Dimitri, et al. "Diagnostic and prognostic utility of brain natriuretic Peptide in subjects admitted to the ICU with hypoxic respiratory failure due to noncardiogenic and cardiogenic pulmonary edema." CHEST Journal 131.4 (2007): 964-971.
Maisel, Alan S., et al. "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure." New England Journal of Medicine 347.3 (2002): 161-167.
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