Pressure at edema
Intensive therapy of cardiogenic pulmonary edema.
Intensive therapy for pulmonary edema begin with giving the patient a sedentary orsemi-sitting position in the bed. If necessary, the patient is transported only on a sitting gurney. Putting the patient on his back is absolutely contraindicated.
Oxygen therapy is carried out by inhalation of oxygen through the nasal cavitycatheters, through the mask of the anesthesia apparatus. Oxygen is needed already at the earliest stages of pulmonary edema, since the diffusion permeability of the alveolar-capillary membrane for oxygen is 20-25 times less than for carbon dioxide. Therefore, with cardiogenic pulmonary edema, the diffusion of oxygen through the alveolar-capillary membrane is initially reduced, which causes hypoxaemia with normo- or hypocapnia (with tachypnea). In addition, oxygen therapy removes, reduces or slows the development of bronchospasm arising in response to hypoxemia, and thereby reduces the impact of bronchospasm on the development of pulmonary edema (increased energy consumption for breathing, negative pressure in the alveoli).
In the phase of alveolar edema in the airways there is a frothysputum, which causes resistance to the flow, disrupts the distribution and diffusion of the gas flow in the bronchial tree. For "defoaming" use inhalation of 30% of ethyl alcohol. Ethyl alcohol is also used intravenously (5 ml of 96 ° alcohol diluted in 15 ml of 5-10% glucose solution). It is believed that ethyl alcohol reduces the surface tension of the foam and thereby contributes to its deposition.
In conditions of pulmonary edema with cardialgia and / or with psychomotorexcitation it is expedient to prescribe 5-10 mg of morphine intravenously, which has analgesic, sedative effect, causes peripheral vasodilation and reduces the activity of the respiratory center.
However, it should be remembered that in patients with chronic pulmonary insufficiency. with respiratory or metabolic acidosis, morphine inhibition of the respiratory center with subsequent hypoventilation can significantly reduce blood pH.
Contraindications for the use of morphine serve ONMI, cerebral edema, lack of consciousness,convulsive syndrome, Cheyne-Stokes breathing, obstructive ONE. Morphin is useful in patients of young and middle age without severe disruption of the respiratory center and without hypertension.
To enhance the effect of narcotic drugs analgesics in the treatment of pulmonary edema neuroleptics and antihistamines (droperidol, suprastin) are used.
Analgesic and sedative therapy. reducing pain and psychomotor agitation,reduces the activation of the sympathetic adrenal system, oxygen consumption by the body, normalizes hemodynamic parameters and promotes more successful treatment of cardiogenic pulmonary edema.
To reduce blood pressure in the venous section capillaries of the lungs, it is necessary to reduce the flow of blood to the "right" heart or increase the outflow of blood from the lungs.
To reduce the flow of blood to the "right" heart is recommended superpositionvenous tourniquets on the lower (upper third of the thigh) and / or upper limbs (upper third of the shoulder) for 20-30 minutes, and the pulse distal to the clamping point should not disappear. Remove the tourniquet from the limb gradually with relaxation for 1-2 minutes, in order to avoid a sharp increase in BCC. The plaits are removed alternately, with an interval of 5-7 minutes.
With arterial hypertension or high CVP is allowed to bleed in the volume of 300-700 ml or the use of hot foot baths.
Intravenous ganglion blockers (pentamine) allows to effectively conductcontrolled reduction in blood pressure for pulmonary edema. When appointing and introducing ganglion blockers, it is necessary to monitor blood pressure, pulse and CVP. Control of CVP is necessary to assess the degree of decrease in venous return of blood to the heart as one of the factors affecting pulmonary edema and the measure of the evaluation of the therapeutic effect of ganglionic blockade.
Effective drugs for treatment of pulmonary edema are nitroglycerin and sodium nitroprusside,which reduce both pre- and afterload. The advantage of nitroglycerin is coronary dilatation, which makes it possible to use the drug against the background of pulmonary edema caused by acute myocardial infarction. Nitroprusside Narya due to a relatively more pronounced decrease in the loading is useful in cases of acute failure of the arterial valve or rupture of the interventricular septum.
Nitroglycerine is administered under the tongue at a dose of 0.4-0.6 mg san interval of 5-10 minutes to 4-5 times. At a blood pressure level of more than 100 mm Hg. Art. nitroglycerin is used intravenously at a rate of 0.3-0.5 μg / kg * min. (isoket 0,1% - 10 ml, has a delayed and prolonged effect in comparison with nitroglycerin).
When nitrates are ineffective. when swelling of the lungs against a background of mitral oraortic insufficiency, with arterial hypertension, it is advisable to administer sodium nitroprusside at an initial dose of 0.1 μg / kg-min, which is gradually increased to clinical improvement in the patient's condition and hemodynamic parameters. When you administer the drug, you need to carefully monitor the level of blood pressure, due to the danger of developing severe poorly controlled arterial hypotension.
Reducing the VTSP and reduction of blood flow to the "right" heart can be achieved by stimulating diuresis by intravenous administration of furosemide in a dose of 40-80 mg.
For "seals "membranes, whose functions under hypoxic conditions,hypercapnia and acidosis are disrupted, intravenously administered glucocorticosteroids (prednisolone 90-120 mg, hydrocortisone 400-600 mg, dexamethasone 4-8 mg), which are indicated for pulmonary edema on the background of respiratory distress syndrome, shock, trauma, infection. With cardiogenic pulmonary edema, which has developed due to arterial hypertension, the effectiveness of glucocorticosteroids is questionable.