Psychological and non-cardiogenic pulmonary edema
Most of the pulmonary edema seen in ordinary hospitals is cardiogenic pulmonary edema, which is pulmonary edema caused by cardiac dysfunction. High altitude pulmonary edema (HAPE) is not psychogenic. Pulmonary edema is rare in hospitals, and high-altitude pulmonary edema is even rarer, so most doctors in Taiwan have little knowledge of high-altitude pulmonary edema.
The difference between psychogenic and non-cardiogenic pulmonary edema is mainly due to the former's cardiac dysfunction and pulmonary venous pressure being too high, while the latter's normal normal pulmonary venous pressure is normal or low. In the former treatment, diuretics play an important role due to diuresis. Will reduce blood volume and reduce pulmonary vein pressure and improve pulmonary edema; In the latter, the blood volume may have been low, the cardiac output is low, if the use of diuretics may make cardiac output lower, the treatment of pulmonary edema may also be Help.
It is impossible to directly measure the pulmonary venous pressure in clinical practice. The catheter is inserted into the wedge of the pulmonary artery to tighten the blood vessel. The measured pulmonary vein pressure is represented by the microvessel pressure. It is called the pulmonary artery wedge pressure. The pulmonary artery in patients with high altitude pulmonary edema has been confirmed since the 1960s. Wedge pressure is normal or low.
Diuretics are used to treat high-altitude pulmonary edema, and furosemide was reported in 1965 or earlier, but its efficacy may be due to factors such as altitude drop, oxygen use, bed rest and other factors. Diuretics are recommended for high altitude pulmonary edema.
Acetazolamide (Diamox) This medicine is a diuretic which also stimulates respiratory function; it is used for the prevention and treatment of "acute mountain sickness (AMS)" and has a certain degree of effect due to irritating breathing, but it has never been used for HAPE. The report.
Current drugs for HAPE are mainly vasodilators, such as nifedipine, which have a certain degree of efficacy. Vasodilators cause elevated pulmonary artery pressure in patients with HAPE. One of the characteristics of HAPE is that pulmonary artery pressure is too high, but nifedipine's Whether the curative effect is due to the reduction of pulmonary arterial pressure is still a mystery, because the true pathological changes that occur in HAPE are still confusing.
The concept that has been repeatedly emphasized in the literature: HAPE treatment is not the most important drug; and altitude drops, oxygen, high pressure treatment, these are far more important and effective than drugs, in addition, warmth and rest are also important additional measures.
References:
The following is a review article, you can find the source of the original report from the end references.
1. Richalet JP: High altitude pulmonary oedema: still a place for controversy? Thorax, 50: 923-929, 1995.
2. Bartsch P: High altitude pulmonary edema. Medicine & Science In Sports & Exercise, 31 (1) (suppl.): s23-27, 1999.
3. Peter H. Hackett et Robert C. Roach: High-Altitude Medicine. In: Paul S. Auerbach ed.: Wilderness Medicine, management of wilderness and environmental emergencies, 3rd ed., 1995. Mosby, St. Louis.
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