Not cardiogenic fluid lungs develops regardless of a dose of medicines, falls to its share to 10% of all zhizneugrozhayushchy states. In recent years its prevalence increases in connection with expansion of an arsenal of medicines.
Etiology and pathogeny of a disease
Medicines which use can lead to edematization of lungs:
• narcotic analgetics; • NPVS; • cytostatics (according to some information the fluid lungs arises at 20% of patients); • diuretics (seldom); • tokolitik (seldom). Damage of a pulmonary endothelium with increase in vascular permeability is the cornerstone of a pathogeny of not cardiogenic fluid lungs. Risk factors of edematization of lungs against reception of NPVS: • advanced age; • long experience of smoking. Risk factors of edematization of lungs at use of tokolitik: • large volume of intravenously entered liquid; • polycarpous pregnancy; • anemia; • the previous treatment of GKS; • an unstable hemodynamics at mother. These risk factors promote decrease in peripheric vascular resistance that leads to a liquid delay in vessels of lungs.
Clinical signs and symptoms of an illness
Clinical manifestations arise in several hours after use of medicines and include: • heavy asthma; • cyanosis; • cough; • thorax pain; • arterial hypotonia; • tachycardia. Acute respiratory insufficiency is one of key symptoms.
The diagnosis and the recommended clinical trials
At physical inspection the dullness over all surface of a thorax attracts attention, at auscultation mixed wet rattles are listened. Radiological lowering of transparency of pulmonary fabric due to strengthening of pulmonary drawing, a multiple melkoochagovy infiltration is defined. Quite often in a pleural cavity the exudate comes to light.
Unlike cardiogenic, the fluid lungs lekarstvenno caused is characterized by a long current; it can proceed without typical symptoms or with insignificant manifestations (cough, a stethalgia). Edematous liquid contains a large amount of protein. Venous pressure remains within norm. The sizes of heart can not change.
General principles of treatment
Treatment of patients with not cardiogenic fluid lungs is carried out by the general principles of therapy of a fluid lungs. Pathogenetic use of GKS is proved: Prednisolonum in/in 300 — 500 mg/days before stopping of symptoms
After achievement of clinical effect: Prednisolonum inside 1mg/kg with a dose decline on 5 mg/week before full cancellation
Assessment of efficiency of treatment
Criterion of efficiency of treatment is reduction of expressiveness of hemodynamic and respiratory disturbances, positive radiological dynamics.
Mistakes and unreasonable appointments
Frequent mistakes: • continuation of reception of medicines; • introduction of large volume of plasma substitutes (strengthens a fluid lungs). Irrational therapy of a medicinal fluid lungs is caused, as a rule, by difficulties and mistakes at establishment of its not cardiogenic genesis.
The forecast is serious, death rate high. The forecast at the fluid lungs caused by reception of diuretics, favorable. After cancellation of medicine there is a fast normalization of a state.