A 55-year-old man develops acute pulmonary oedema intraoperatively. ABG: pH 7.36, PaO2 58 on FiO2 0.6. Pulmonary artery occlusion pressure (PAOP) is 28 mmHg. What type of pulmonary oedema is this, and what is the FIRST treatment priority?
- A Non-cardiogenic (ARDS); increase PEEP and restrict fluids
- B Neurogenic; administer high-dose methylprednisolone
- C Transfusion-related (TRALI); administer corticosteroids and diuretics
- D Cardiogenic; administer IV furosemide and reduce preload ✓
Explanation
A PAOP greater than 18 mmHg distinguishes cardiogenic from non-cardiogenic pulmonary oedema; this patient's PAOP of 28 mmHg confirms cardiogenic aetiology (elevated left atrial filling pressure). The first treatment priority is preload reduction with IV furosemide (diuresis) along with nitrates to reduce both preload and afterload, supplemental oxygen, and possibly non-invasive ventilation if hypoxaemia is severe. ARDS (non-cardiogenic) is defined by a PAOP ≤ 18 mmHg or absence of clinical evidence of elevated left atrial pressure. TRALI occurs within 6 hours of blood product transfusion and also has a low PAOP.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.