Investigations

Key investigations for pulmonary oedema include:

• Bedside observations
• Arterial blood gas analysis
• Electrocardiogram (ECG)
• Troponin levels if a new cardiac event is suspected
• Serum B-type Natriuretic Peptide (BNP)
• Chest X-ray

Management

The management of pulmonary oedema involves several steps:

• Adopting an ABCDE approach
• Positioning the patient upright
• Administering oxygen
• Establishing IV access
• Administering IV Furosemide
• Considering non-invasive ventilation such as Continuous Positive Airway Pressure (CPAP) if initial medical therapy fails, usually in an intensive care setting.
• Invasive ventilation and inotropic support should be considered in an ICU setting if the above measures fail.

Special considerations must be taken when managing patients with concurrent heart failure and renal impairment, or heart failure with hypotension. As with any medical condition, management strategies should aim to reverse the acute trigger of the deterioration or employ definitive therapy, as appropriate.