Pulmonary edema natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Some patients may need to use a breathing machine for a long time, which may lead to damage to lung tissue. Kidney failure and damage to other major organs may occur if blood and oxygen flow are not restored promptly. If not treated, this condition can be fatal. If left untreated, acute pulmonary edema can lead to coma and even death, generally due to its main complication of hypoxia.

Natural History

• If left untreated, acute pulmonary edema can lead to respiratory arrest, coma and death, generally due to its main complication of hypoxia

• Some patients may need to use a breathing machine for a long time, which may lead to damage to lung tissue

Complications

Common complications of pulmonary edema include:

• Respiratory arrest

• Leg swelling (edema)
• Abdominal swelling (ascites)
• Pleural effusion
• Congestion of liver
• Myocardial infarction (MI)
• Cardiogenic shock
• Arrhythmias
• Electrolyte disturbances
• Mesenteric insufficiency
• Protein enteropathy
• Death

Prognosis

Prognosis of non-cardiogenic pulmonary edema is generally good and responds well to treatment, while cardiogenic pulmonary edema has a variable mortality rate.

• In-hospital mortality rates in a high-acuity setting, are 15-20%.

The prognosis for patients with acute pulmonary edema depends on the:

• Underlying cause
• The patient's age
• Comorbidities
• Prompt diagnosis
• Initiation of effective treatment

The following features are associated with a worse outcome:

• Advanced Age
• Wide QRS complex
• Hyponatremia
• Low Left Ventricular Ejection Fraction
• Hypotension
• Precipitated by ischaemia
• Previous hospitalisation for heart failure
• Marked BNP elevation
• Elevated troponin