![]() Recent or current blood transfusions, risk factors for pulmonary embolism, and recent thoracic surgery should be considered. History should also include medication review, specifically opioid and salicylate use, as these can rarely cause noncardiogenic pulmonary edema. A thorough evaluation should occur as disease processes such as ARDS can occur in the setting of an increased inflammatory response in the body, such as sepsis, trauma, pneumonia, and pancreatitis. Depending on the specific etiology, this could happen very rapidly. History will include a patient who has had progressive worsening of respiratory status and increasing dyspnea. ![]() Female donors have a higher incidence of TRALI this was thought to be due to human leukocyte antigen (HLA) antibiotics found in parous female donors. TRALI also has increased incidence in blood products with a higher ratio of plasma content, with 1 in 2000 plasma containing components and 1 in 400 whole blood products. TRALI is the leading cause of death from a blood transfusion and is more commonly seen in critically ill patients, as these patients often require more transfused blood products and can be found in 1 of 5000 units of packed red blood cells. HAPE is a rare disease that does not have a systematic epidemiologic analysis however, those who have risk factors for acute mountain sickness with an ascent to altitudes greater than 2250 meters are at risk for HAPE. ARDS is also responsible for 10% of intensive care unit (ICU) admissions globally. ARDS affects roughly 200000 patients in the United States, 75000 of which are associated with mortality. Most of the different etiologies of noncardiogenic pulmonary edema are rare but are essential to include on broad differential diagnosis in the appropriate clinical setting. Treatment is specific to the underlying etiology, and all require prompt recognition as clinical decline can be rapid and severe. It includes other etiologies, including high altitude pulmonary edema, neurogenic pulmonary edema, opioid overdose, salicylate toxicity, pulmonary embolism, and reexpansion pulmonary edema, reperfusion pulmonary edema, and transfusion-related acute lung injury (TRALI). The scope of noncardiogenic pulmonary edema is much broader than ARDS. Clinical context also necessitates no evidence of acute heart failure or hypervolemia in the setting of ARDS. Diagnosis of ARDS also requires bilateral infiltrates on chest radiograph with a ratio of the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) to be less than 300 mmHg with positive end-expiratory pressure (PEEP) of 5 cmH2O. Arguably the most recognized form of noncardiogenic pulmonary edema is acute respiratory distress syndrome (ARDS), which is a noncardiogenic pulmonary edema that has an acute onset secondary to an underlying inflammatory process such as sepsis, pneumonia, gastric aspiration, blood transfusion, pancreatitis, multisystem trauma or trauma to the chest wall, or drug overdose. These findings suggest a noncardiogenic source. An echocardiogram may also be used to confirm a lack of acute systolic or diastolic dysfunction. ![]() Chest imaging may reveal a peripheral distribution of bilateral infiltrates with no evidence of excessive pulmonary vasculature congestion or cardiomegaly. Other findings during the patient's initial evaluation may include a lack of acute cardiac disease or inappropriate fluid balance, flat neck veins, and the absence of peripheral edema. ![]() This is important to differentiate as the management changes based on this distinction. To differentiate from cardiogenic pulmonary edema, pulmonary capillary wedge pressure is not elevated and remains less than 18 mmHg. Increased capillary permeability and changes in pressure gradients within the pulmonary capillaries and vasculature are mechanisms for which noncardiogenic pulmonary edema occurs. The disease process has multiple etiologies, all of which require prompt recognition and intervention. Noncardiogenic pulmonary edema is a disease process that results in acute hypoxia secondary to a rapid deterioration in respiratory status.
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