Pulmonary edema in cats and cats: timely diagnosis and treatment. Pulmonary edema in a cat: symptoms and treatment

Pulmonary edema is an acute condition in which the amount of fluid in the lung space exceeds the normal level, which leads to impaired gas exchange.

When this pathology appears, the owners often think: “Is it possible to cure pulmonary edema in a cat, and is this condition fatal or not?”. Treatment for pulmonary edema depends on the severity and cause. With minimal suspicion of pulmonary edema, the animal should be immediately taken to a veterinary clinic, since it is almost impossible to stabilize the condition at home. The prognosis of this disease is cautious, often unfavorable, due to untimely access to a veterinary clinic and treatment.

The causes of pulmonary edema can be different, depending on the type. It is customary to divide them into cardiogenic and non-cardiogenic.

Cardiogenic pulmonary edema is a pathological process that is caused by abnormalities in the work of the heart. When intracapillary pressure rises, the leakage of fluid into the alveoli from the capillaries is disrupted, and blood accumulates and stagnates in the vessels of the lungs.

Non-cardiogenic pulmonary edema is recognized by non-cardiac problems and often occurs with an increase in the permeability of the walls of the pulmonary vessels. The causes of such a disease can be chest injuries, sepsis, reflux of various liquids, toxic gases into the respiratory tract.

Usually, owners notice symptoms of pulmonary edema such as lethargy, lack of appetite, a posture with the front paws apart, shortness of breath, breathing with an open mouth (like dogs breathe), blue-violet mucous membranes, abdominal breathing, sometimes even wheezing and gurgling are heard. sounds. Rarely cough.

Is pulmonary edema treated and how to remove it? Methods of treatment: first of all, you need to deliver the animal to the veterinary clinic, try to stress less at the moment. When taking an anamnesis, the doctor should immediately put the cat in an oxygen chamber or let him breathe oxygen with the help of a mask; in extreme cases, resuscitation and connection to a ventilator are used to saturate the cells of the body with oxygen. Diuretics (diuretics) are used. First, acute symptoms are stopped, then they try to eliminate the causes, if possible. To do this, auscultation is performed (they listen to the area of ​​​​the lungs with the help of additional devices), an x-ray, a general blood test is taken in order to diagnose the underlying disease. More often, your pet with a diagnosis of pulmonary edema is placed in a hospital, as constant monitoring of the animal is required, the use of various therapeutic and diagnostic measures.

Sequelae of pulmonary edema

Pulmonary edema is an extremely serious condition and often after it there are serious consequences. Due to prolonged hypoxia (lack of oxygen), the brain and cardiovascular system are more often affected.

Prevention

In order to prevent pulmonary edema in cats, it is necessary to monitor the general condition of the animal, treat lung and heart diseases in time, and with various symptoms (shortness of breath, cough, lethargy), immediately contact the clinic. The risk group includes cats of certain breeds (British, Scottish, Maine Coons, Persian, Sphynx), obese, prone to low physical activity. Owners with cats with heart and circulatory problems need to be monitored more seriously.

Particular attention should be paid to postoperative cats that have recently undergone surgery under general anesthesia (for example, a cat after spaying). When the animal has had heart problems, anesthesia can trigger the development of pulmonary edema, but this does not always appear immediately, it can happen in the next couple of weeks after surgery. Therefore, before various operations, even the most common sterilization, one should undergo a cardiological examination to diagnose various cardiac pathologies and reduce the risk of surgical intervention.

Our VetMaster center has everything you need to diagnose and stabilize the condition in case of pulmonary edema: a mask and an oxygen chamber, an oxygenator, a ventilator, cardiac monitoring, a digital X-ray machine, and a 24-hour hospital.

Pulmonary edema in cats is a serious disease of pets. There is an excessive filling of the capillaries of the lungs with blood, due to which the fluid is excreted into the tissues surrounding the capillaries. There are two types - cardiogenic and non-cardiogenic.

Causes of pulmonary edema in cats

The photo shows an ultrasound of a 10-year-old cat with pulmonary edema.

Causes of a cardiac nature are called cardiogenic. This type of flow occurs with heart failure. Insufficient work of the left ventricle provokes a violation of the pulmonary circulation, which, in turn, provokes stagnation of blood in the lungs and the withdrawal of water into the surrounding tissues.

Diseases that are provoking factors:

• aortic heart disease;
• mitral heart disease;
• pulmonary embolism.

With cardiogenic factors, the lower parts begin to swell with a gradual transition to the bronchi.

In this state of affairs, the pulmonary alveoli cannot carry out normal gas exchange, as a result of which the cat experiences oxygen starvation, suffers from suffocation, and dies with untimely help. The prognosis of cardiogenic edema is unfavorable.

Non-cardiogenic causes

Pulmonary edema can be caused by electric shock.

All other causes that provoked pulmonary edema are called non-cardiogenic. The factors are:

• hot air entering the lungs by inhalation;
• prolonged inhalation of chemical toxic gases;
• croupous pneumonia;
• overheating thermal or solar;
• infections of a viral or bacterial nature - pasteurellosis, plague;
• electric shock;
• brain injury;
• the presence of septic processes;
• overdose of toxic drugs;
• asthma;
• malignant tumors.

Asthma can also cause pulmonary edema.

Diagnosis of pulmonary edema is based on the collection of anamnesis, visible symptoms, and medical history. By listening to the lungs, radiography.

Symptoms of pulmonary edema

Elderly animals suffering from heart disease are most susceptible to the disease.

The main signs of the disease are manifested in the behavior of the cat. The pet spreads its legs wide and tilts its head, trying to inhale the air. When touched, cold paws are felt. The animal can lie on its side for a long time, unable to rise any more.

In the first place, fear appears in the look, the eyes become empty, the cat's panic is felt.

• The pet does not respond to the environment, the call of the owner.
• The pallor of the mucous membranes of the mouth is visible, followed by cyanosis.
• Breathing is difficult, accompanied by the release of pinkish sputum. heard when coughing bubbling or gurgling sounds. Nasal and oral frothy discharge is possible, while the tongue protrudes outward.
• Rapid heartbeat, followed by a transition to intermittent and weak.

With pulmonary edema, the look of the cat will be panicky.

It ends with paralysis of the respiratory nerves and animal death . The disease is very acute, lightning-fast, but according to some signs, it can be noticed in time and treatment can be started immediately. The onset of the disease is manifested by confused breathing. The cat is more likely to breathe through its belly or open mouth. Respiration is very frequent and confused, with occasional short cough.

Having noticed such signs, the owner should immediately contact the clinic, otherwise delay threatens the inevitable death of the pet.

Is it possible to cure pulmonary edema in a cat

Trying to Help Your Pet will inevitably end with the death of the latter. It's not even worth trying. Take your cat to the clinic as soon as possible. The only help of the host may be furasemide to remove excess fluid.

But this measure is permissible only with full confidence that the cause lies in heart failure. An important condition when collecting to the clinic is to prevent the animal from becoming nervous in order to avoid complications during a new attack.

Resuscitation assistance consists in the use of an oxygen cushion, in more difficult cases, a tracheotomy is performed.

The appointment of diuretic drugs - diuretics is recommended. Apply defoamers, vasodilating drugs. Cardiac drugs to restore the work of the heart. Carry out bloodletting, novocaine blockade of sympathetic nodes. After the acute signs have been eliminated, the cat is placed in a cool room with good ventilation, while it is important to avoid drafts.

The hospital maintains a cool temperature with good ventilation, but no draft

Symptomatic therapy is indicated: expectorants, antibiotics. It is important to establish an accurate diagnosis and, after the crisis has been eliminated, apply narrow-profile therapy.

Disease prevention

Pulmonary edema is a very serious disease, which in most cases ends in the death of the animal, so it is very important to follow the rules of necessary prevention.

Realize constant strict control over pets at risk: animals suffering from obesity, leading a sedentary lifestyle. It is necessary to keep an eye on pets with heart disease who have a genetic predisposition to heart disease.

Watch out for lazy cats!

Knowing about the heart problems of a pet, you should carefully monitor all changes in his behavior and, at the slightest alarming signs, immediately contact a veterinarian.

conclusions

From the foregoing, we can conclude that pulmonary edema is a serious illness with an unfavorable prognosis at the slightest delay, but it can be treated if it is treated with due attention and care to pets. Timely access to the doctor is the key to a long life of the pet.

Pulmonary edema- a condition in which the fluid content in the pulmonary interstitium increases, which leads to a violation of gas exchange. This is an acute condition that requires a mandatory visit to the veterinary clinic.

Pulmonary edema is manifested by shortness of breath, suffocation, cyanosis of the mucous membranes, wheezing when breathing and serious respiratory failure (the cat breathes heavily). A cat with pulmonary edema may cough, breathe with an open mouth - all of these symptoms require a visit to the doctor.

Pulmonary edema can be cardiogenic or non-cardiogenic.

The reasons

Cardiogenic causes are associated with various diseases of the cardiovascular system.

The most frequent cardiogenic The causes of pulmonary edema in cats will be the following diseases:

• cardiomyopathy;
• heart disease;
• pulmonary embolism.

It is in connection with the risk of developing cardiogenic pulmonary edema that all cats before any anesthesia are recommended to have an ECHO of the heart. HCM occurs in all cats, but there are risk group breeds in which this pathology is much more common - for example, in British, Scottish cats and their mestizos, Maine Coons, Norwegian Forest cats.

Non-cardiogenic causes of pulmonary edema in cats:

• multiple organ failure, sepsis;
• respiratory failure (foreign body, brachycephalic syndrome, neoplasms of the respiratory tract and lungs;
• aspiration (inhalation) of vomit, food, water;
• cat poisoning (gases, poisons);
• transfusion hypervolemia (with excessive intravenous infusion).

A state of shock in a cat can occur as a result of a burn, a chest injury, an acute allergic reaction, or sepsis.

Symptoms

If two or more signs occur, the owner should immediately contact the clinic, especially if the pet has cardiac problems or has recently been under anesthesia (up to 2 weeks). Symptoms may be associated with other lung pathologies, but in any case, this means that the cat needs medical attention.

Signs of a condition such as pulmonary edema are:

• Shortness of breath, abdominal type of breathing (the cat breathes in the stomach).
• Rattling and gurgling when the cat breathes.
• Breathing with an open mouth "like dogs". This type of breathing is uncharacteristic for cats, only for one to two minutes after physical activity.
• Cyanosis (the mucous membranes of a cat are blue or purple).
• Severe lethargy and weakness due to hypoxia (lack of oxygen).

Diagnosis of pulmonary edema

Diagnosis of pulmonary edema in cats is based on the history of the disease, clinical symptoms, auscultation (listening to lung sounds), and radiography. However, if the cat is in a critical condition and there is a threat to life, primary treatment should be carried out without additional diagnostics until the condition stabilizes.

After the relief of an acute condition (the treatment algorithm is similar, regardless of the cause), additional diagnostics should be carried out to determine the cause.

Treatment of pulmonary edema in cats

Pulmonary edema in cats is a dangerous, life-threatening condition that requires an emergency visit to the doctor. Treatment of pulmonary edema should be in a veterinary clinic with constant monitoring of the state of the cat in a hospital. This is a condition that requires not only intensive care, but often resuscitation.

Severe cases of pulmonary edema require medical equipment (ventilator, oxygen unit). Therefore, the sooner you deliver the cat to the clinic, the more chances there will be for the stabilization of the animal's condition. Procrastination can be fatal for your cat.

It is necessary to provide the cat with rest, oxygen therapy (oxygen supply with a mask or placement in an oxygen chamber). All drugs are administered mainly intravenously or intratracheally.

A dropper is prescribed to restore electrolyte balance. Diuretics (diuretics), in some cases steroid hormones are used. It is also possible that there will be a need to connect the animal to a ventilator.

First of all, acute symptoms are stopped, the condition stabilizes, then pathogenetic treatment follows, that is, the elimination of the cause, if possible.

- one of the simplest, typical types of surgical intervention in the world veterinary practice. Thousands of such operations are performed daily. This procedure is simple and can be performed even at home ... however, this does not exclude a certain risk of complications. These include pulmonary edema after castration. Pathology is very rare, but still occurs.

With this pathology, the lumen of the bronchi and pulmonary alveoli are filled with foamy contents, there is a strong degree of blood filling. Under such conditions, air exchange is much more complicated or impossible at all, as a result of which the animal, if it is not provided with qualified assistance in the shortest possible time, will die from suffocation.

Usually, in the development of pulmonary edema is to blame for the heart, which in aged animals is often worn out and enlarged. Problems lead to congestion in the pulmonary circulation. With general anesthesia, the load on the organ increases (plus possible “side effects” from anesthetics), as a result of which the left atrium and ventricle can no longer cope with their work. They pass part of the pumped blood in the opposite direction, which is why a lot of "surplus" accumulates in the vessels of the respiratory system. Gradually, the blood plasma squeezes out into the lumen of the bronchi and alveoli, which, as we already remember, develops edema.

Clinical picture of pathology

It is quite simple and characteristic, the symptoms are pronounced and clearly visible even to an inexperienced breeder. The animal suddenly begins to choke, its breathing becomes intermittent and hoarse. All visible mucous membranes turn blue, the body temperature may rise slightly at first, but then it always drops so that even the cat's skin becomes noticeably cooler than normal. The pet suffocates, coughs heavily, flaky pieces of foam periodically fly out of its nasal openings and mouth.

Note that pulmonary edema in a cat does not always develop immediately after castration. Many cases have been described when animals “fell down” a week after the operation! By the way, in such cases it can be extremely difficult to link sterilization and edema. It is possible that more than 70% of the "postponed" cases actually have nothing to do with castration and are caused, for example, by poisoning. Since cases are rare, no one has simply conducted detailed studies. What are the causes of "true", postoperative pulmonary edema?

Major predisposing factors

Very often this happens in cases where the operated cat has cardiomyopathy. With this pathology, the heart can either turn into a kind of flabby bag (dilated variety), or shrink due to the growth of connective tissue. There are also transitional and mixed varieties.

Regardless of the type of illness, it always leads to the same thing - the organ ceases to perform its function normally, congestion develops in the pulmonary circulation. In this case, any operations, including castration, are strongly contraindicated. In addition, a sick cat will have to be treated for the rest of his life so that his quality of life remains at an acceptable level.

This includes all types of allergies.. If your pet is predisposed to their development, we strongly advise you not to "randomly" castrate the cat. Take him to the veterinarian in a good clinic ahead of time, let the specialist test different types of sedatives and select the one with which the likelihood of developing an allergic reaction will be as low as possible. Otherwise, it may well happen that the pet dies of suffocation right on the operating table.

Finally, never to be discounted individual intolerance to drugs. So, in the recent past, xylazine was very often used for anesthesia (and even now it is often used). This medicine very often provokes the development of pulmonary edema in cats, and there are many cases of a "delayed" variant of the pathology. True, it is extremely difficult to prove the relationship between xylazine and edema that occurred a week after surgery. But experts and experienced breeders are sure that the relationship exists.

Treatment

What treatment is prescribed for the development of pathology? Urgent. If this happened during the operation, then, of course, it should not be interrupted. It is urgent to intubate the cat, ensuring the proper degree of oxygenation of the tissues of the animal, to introduce drugs that support the respiratory and pulmonary function of the pet.

If there is a suspicion of an allergic nature of the pathology, antihistamine drugs are administered in loading doses. Of course, in such cases, the cat should not be sent home immediately. He must be under the supervision of a veterinarian for at least a day.

When the animal recovers from anesthesia, during the first three hours he is strictly forbidden to give much to drink. Subsequently, the pet is prescribed diuretic drugs that can prevent recurrence of edematous phenomena. In addition, a complete medical examination of the cat is mandatory. Its purpose is to find out under the influence of which reasons the development of pulmonary edema occurred. For this purpose, the following diagnostic methods are used:

• Studies of blood, urine, other biological fluids.
• Ultrasound and chest x-ray. Particular attention should be paid to the condition of the heart.

Further therapeutic methods directly depend on the pathologies identified during a complete medical examination of the cat.

The owners of such amazing animals can say the following in this article. If you notice your cat is short of breath, the first thing to do is contact your veterinarian. urgently. Why? Because shortness of breath in a cat is a very, very bad sign, which may indicate the onset of pulmonary edema. It should be noted that the term dyspnea” refers to breathing with an open mouth and protruding tongue, more frequent than usual, “belly” breathing. In the future, cyanosis (cyanosis) of the mucous membranes, lethargy, forced position of the body lying on the sternum with the elbow joints apart to the sides join this symptom. There may be a wet cough with sputum. Are we seeing any of this? So urgently to the clinic. Urgent, but don't panic. In the bustle, the animal will experience stress and the condition may worsen. But you, unfortunately, cannot help the cat at home.

As practice shows, in the treatment of pulmonary edema, we often make mistakes, acting according to patterns, without thinking about the physiology of a particular case. In this article, we will try to thoroughly analyze several reasons for the development of this process.

Let's start, as usual, at the beginning, namely with anatomy and physiology.

The air that the cat inhales moves down the trachea, which divides into two bronchi (tracheal bifurcation) - the right and left. Each bronchus continues with smaller airways already in the lungs - bronchioles, which end in small vesicles - alveoli. They seem to be shrouded in blood vessels, being separated from the blood by a thin membrane, through which the erythrocyte is enriched with oxygen and carbon dioxide is removed.

Pulmonary edema- this is a condition in which fluid accumulates outside the vessels of the lungs (in the lung connective tissue - interstitium, in the alveoli, in the bronchioles). The mechanisms of edema development are divided:

1. Due to increased hydrostatic pressure.

2. Due to increased vascular permeability.

3. Mixed reasons.

Decompensation occurs when the rate of formation of interstitial fluid suppresses the mechanisms of protective clearance, which include correction of interstitial hydrostatic and oncotic pressure and increased lymphatic outflow.

In this article we will lead the story, dividing the forms into cardiogenic and non-cardiogenic .

Cardiogenic pulmonary edema is a consequence of increased hydrostatic pressure in the vessels caused by left-sided heart failure. In cats, the most common heart disease leading to this pathology is hypertrophic cardiomyopathy ( GKMP). On the example of this pathology, we will consider the mechanism of edema development. With this diagnosis, the walls of the left ventricle thicken, and the contractility of the heart muscle decreases.

With the progression of the disease, the pressure in the left atrium increases due to obstructed outflow of blood. Since blood enters the left atrium from the pulmonary veins, pressure also increases in the vessels of the lungs. First, correction of hydrostatic and oncotic pressure and increased lymphatic drainage protect the lungs from excess fluid. But over time, these mechanisms decompensate. The great difficulty is that a cat with this disease may not show any clinical signs, and under stress (for example, when transporting to a vaccination clinic) suddenly die from pulmonary edema. It is for this reason that cats genetically predisposed to HCM undergo additional cardiac tests even before elective surgery. Indeed, in case of confirmation of the disease, the owners have the opportunity to reconsider the need for surgical intervention, and the anesthetists have data on the level anesthesia risks. And even if no operations are planned, and your cat has a breed predisposition to cardiac pathology, it will be right for the first years of life to be observed by a cardiologist, conducting an echocardiogram (ultrasound of the heart) every 6 months in order not to miss a possible disease and take it under control in time. Breeds prone to HCM: Maine Coon, Ragdoll, Sphynx, British Shorthair, Scottish Fold, Norwegian Forest, Persian.

In addition to cardiogenic edema of the type of increased hydrostatic pressure, edema also occurs against the background of incorrect infusion therapy.

To non-cardiogenic include several forms of edema associated with vasculitis and numerous diseases that can lead to a systemic inflammatory response or pathologies of the central nervous system.

Quite a few inflammatory diseases can lead to systemic inflammatory response syndrome (SIRS). SIRS), which is thought to result from an imbalance between systemic inflammatory and anti-inflammatory mediators. Inflammation occurring at one site causes leukocyte activation and release of numerous cytokines, oxygen metabolites, and other inflammatory mediators that can initiate activation of the complement and coagulation cascades. As the inflammatory and coagulation cascades increase, an imbalance of anti-inflammatory and anticoagulant factors can lead to SIRS and cause direct cytokine- or leukocyte-mediated damage to the pulmonary capillary endothelium. As a result, capillary permeability increases, and plasma proteins with inflammatory mediators penetrate into the lung structures. This fluid flow leads to pulmonary edema and, if severe, can cause acute respiratory distress syndrome ( ARDS).

Both SIRS and ARDS occur secondary to other diseases that may reside primarily in the lungs or other organs (sepsis, pancreatitis, pneumonia, extensive tissue injury, immune disease, and metastatic neoplasia). Also, the causes of increased vascular permeability are pulmonary embolism, ventilation-associated lung injury, toxic lung injury (volatile hydrocarbons and cisplatin).

Neurogenic pulmonary edema (non-cardiogenic pulmonary edema due to barotrauma) occurs in our patients most often as a result of head trauma, seizures, upper airway obstruction, or electrical shock. Although the true pathophysiology has not been elucidated, it is thought to be a direct result of massive central sympathetic nerve stimulation. Large amounts of catecholamines (eg, epinephrine, norepinephrine) are released into the bloodstream. They are known to cause severe pulmonary venous and peripheral vasoconstriction (vasoconstriction), leading to pulmonary and systemic hypertension, respectively. An increase in systemic hypertension may, in turn, lead to an increase in left atrial pressure caused by a decrease in cardiac output from increased vascular resistance. This process itself can lead to the development of pulmonary edema due to an increase in hydrostatic pressure in the vascular system.

Diagnosis of pulmonary edema in cats

Important for diagnosis complete medical history. Owners with a pet showing signs of pulmonary edema should be prepared to answer questions about the presence of heart disease and ongoing therapy, or signs of possible heart failure. It also stands still in the place where the animal showed signs of edema, pay attention to open wires, electrical appliances, and in general to the position of the body and the presence of injuries in the cat. Perhaps this will help determine the cause of the pathology.

Expert method, to confirm the diagnosis of "pulmonary edema", is thoracic radiography. In cats with respiratory failure, testing is often difficult and may worsen symptoms due to stress. But on auscultation, rather characteristic large bubbling rales and "gurgling" are usually found. Having made a preliminary diagnosis, you need to start oxygen therapy, make sure that you can conduct a study without worsening the condition and take an x-ray in the dorsoventral projection to confirm the diagnosis and start treatment. A "correct" projection can be performed when the patient is stable enough to cope with the examination and when we have taken care of anxiolysis (anti-anxiety therapy).

To diagnose the cause of edema, it is necessary to carry out complete physical examination, possible with interruptions and periodic return of the patient to the oxygen chamber. The examination should include echocardiography, general clinical and biochemical blood tests, general urinalysis, pulse oximetry. Although none of these tests are diagnostic of non-cardiogenic pulmonary edema ( NCPE), findings may provide clues to an underlying cause if no history indicates heart failure, neurological injury, or if an inflammatory mechanism with subsequent SIRS is suspected.

The radiograph most characteristic of NCPE is increased interstitial or alveolar opacity, most commonly in the caudodorsal lung fields. In severe cases, the infiltrate may become diffuse, however, the caudodorsal fields tend to be more deeply affected. In cardiogenic edema, there may be a focal, almost nodular, diffuse alveolar pattern. In some cases, the pulmonary veins can be seen more clearly than the pulmonary arteries. Darkening of the cranioventral lobes is characteristic of aspiration pneumonia.

Therapy for all types of pulmonary edema includes oxygenation. Cats are best kept in an oxygen chamber, as they Crow's mask and collar cause great stress. However, if it is possible to use anxiolytic drugs, masks can also be used if the patient allows. With the use of a mask, a high percentage (up to 100%) of inhaled oxygen (FiO2) can be achieved at an oxygen rate of 100 to 200 ml/kg/min8 (room air provides approximately 20% FiO2). An ice container must be placed in the oxygen chamber to prevent overheating. Another option for oxygen supplementation is nasal insufflation (nasal cannulas). By placing, under sedation, a nasal catheter can provide FiO2 between 40% and 60% depending on the oxygen flow rate.

In patients with severe respiratory distress, in the absence of a response to the above oxygen therapy, mechanical ventilation may be required(IVL). It is indicated for patients whose arterial blood gas analysis shows an oxygen partial pressure of less than 60 mmHg. or the level of carbon dioxide is more than 60 mm Hg, or the saturation does not rise above 90%. There are conflicting data in the literature on the effect of mechanical ventilation on the resolution of pulmonary edema - in some cases it can help in therapy, in others it can slow down treatment. Therefore, the decision on the need for positive pressure ventilation should be made individually, not to hesitate in the event of a rapid deterioration in the condition, but not to apply unnecessarily.

When using any method of oxygen support requires careful monitoring because prolonged oxygen supplementation can lead to severe consequences, including pulmonary fibrosis. A general rule of thumb is that patients should not be supplemented with 100% oxygen for more than 24 hours or 60% oxygen for more than 48 hours. FiO2 levels of less than 50% are generally considered safe for longer periods.

The body position of the animal - lying on the sternum with the elbows apart, helps with gas exchange, probably by reducing atelectasis.

In patients with cardiogenic pulmonary edema the main therapy after the addition of oxygen is diuretic, such as furosemide, which helps reduce both total fluid volume and increased hydrostatic pressure in the vascular system. It is assumed that furosemide directly affects the ability of the alveolar epithelium to pump fluid from the air space. The drug is administered at a dosage of 1-4 mg / kg 1 time in 4 hours (possibly more often at the beginning of therapy).

In NCPE, the cause of the edema is NOT an increase in fluid volume resulting in an increase in hydrostatic pressure. Therefore, the use of furosemide in these patients may contribute to systemic hypovolemia, which worsen the patient's condition. However, in patients with severe endothelial injury, pulmonary capillary oncotic pressure decreases as a result of protein leakage into the interstitial and alveolar regions, so hydrostatic pressure is the main cause of fluid flow. In other words, the amount of fluid released from the damaged capillary is determined by its total volume passing through the vessel. For this reason, some clinicians advocate the use of furosemide in IRS (constant rate infusion) at a low dose of 0.1 mg/kg/hour.

In case of emergency a useful group are nitric oxide donors, which include nitroglycerin. It rapidly induces vasodilation, thereby reducing preload and afterload. Phosphodiesterase inhibitors such as pimobendan increase cyclic adenosine monophosphate (to increase fluid reabsorption from the alveolar space) and may also be used to treat pulmonary edema, but scientific evidence is lacking.

Since the hydrostatic pressure gradient is very important in the pathogenesis of pulmonary edema, it is reasonable limit fluid administration to these patients. But the decision should be made taking into account the risks of impaired renal function and the development of multiple organ failure. The pulmonary, microvascular barrier is relatively permeable to protein and therefore colloids can increase oncotic pressure in the pulmonary capillaries, resulting in decreased fluid outflow into the interstitium. However, if the pores of the damaged endothelium are large enough to allow penetration of colloids, the administration of these drugs may exacerbate the process. Therefore, bolus administration of drugs (crystalloids and colloids) is not recommended, so as not to cause an acute increase in hydrostatic pressure., but use with PSI is possible.

Therapy with corticosteroids and bronchodilators has not been shown to be useful for the treatment of pulmonary edema.

To stop the progression of pulmonary edema, it is necessary to carry out intensive therapy of the underlying process of the disease. Attempt to compensate for heart failure or disease leading to SIRS or neurological deficit. As a rule, intensive care is required for 24-72 hours until complete elimination of edema.

In the case of a cardiogenic cause, the prognosis is unfavorable, the likelihood of relapse and further deterioration is high. In the non-cardiogenic form, the prognosis is usually favorable if the underlying cause can be established and adequate treatment can be selected.

Bibliography:

1. Noncardiogenic Pulmonary Edema BY ROBERT H. PRESLEY, DVM

JUNE 2006 (VOL 27, NO 6) FOCUS: CARDIOPULMONARY CONSIDERATIONS

2. Small Animal CRITICAL CARE MEDICINE 2009

Deborah C. Silverstein, Kate Hopper

3. Pulmonary edema (Proceedings)

By Elizabeth Rozanski, DVM, DACVIM, DACVECC

CVC IN SAN DIEGO PROCEEDINGS

4. Introduction to Lung and Airway Disorders of Cats

By Ned F. Kuehn, DVM, MS, DACVIM, Section

Chief, Internal Medicine, Michigan Veterinary Specialists

If your cat shows signs of pulmonary edema, then the veterinarians of the VetState veterinary city clinic will help provide emergency care, as well as conduct intensive care and a complete diagnosis of your pet's health and effectively deal with the problem.

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