#518: Noncardiogenic Pulmonary Edema for Nursing Students

Maureen Osuna (0:00)

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Maureen Osuna (2:20)

Well, hello there, I'm Nurse Mo, and this is the Straight A Nursing Podcast, where I teach concepts and share tips to help you thrive in school and at the bedside.

So picture this, you are a nurse in the PACU and you are receiving a patient. He's a 34-year-old male with a past medical history of obesity, loud snoring reported by his spouse. So you kind of suspect some obstructive sleep apnea, but it's not confirmed. This gentleman had an elective septoplasty under general anesthesia with some ketamine mixed in there as well.

Now he gets to in the PACU, he has rapid onset of significant respiratory distress. His SpO2 is dropping and dropping, even with supplemental oxygen, it's not doing great. He has pink frothy sputum and diffuse crackles bilaterally.

So what do we think is going on with this guy? How serious is this? Let's dive into it in this episode.

So what we're dealing with here is non-cardiogenic pulmonary edema. And we'll get into more details around this and more things that you might notice about this patient when you're assessing him. And if you listen to the episode from a couple weeks back, episode, I want to say it was 512 on cardiogenic pulmonary edema. You remember that cardiogenic pulmonary edema is a pressure problem. But with non-cardiogenic pulmonary edema, the problem isn't pressure. The problem is the permeability of the alveolar capillary membrane, which has gotten abnormally permeable or abnormally leaky, allowing fluid and proteins to enter. Now remember, this mechanism is different from cardiogenic edema. The heart is not the source of the problem. The source of the problem is at that alveolar capillary membrane level. It is a permeability problem. And it's important to note that non-cardiogenic pulmonary edema is not a single disease or single condition. It's a category with several distinct causes that all funnel into the same pathophysiological process. We've got a leaky capillary membrane and fluid flooding the alveoli.

So you might be thinking, sounds like there's lots of causes for this. And yes, you would be absolutely right. So some common causes to know, one is ARDS, which is Acute Respiratory Distress Syndrome. It is the most common cause of non-cardiac pulmonary edema overall. Now it develops from an overblown systemic inflammatory response, often triggered by sepsis, pneumonia, trauma to the lungs, pancreatitis, even aspiration. And these insults to the lungs damage the capillary membrane directly. And ARDS has a really high mortality rate. And I do have more information about ARDS in another episode. If you want to learn about ARDS, then go and check out episode, I want to say it's episode 137