Left ventricular systolic heart failure resulting in acute pulmonary oedema; Pathophysiology and nursing management in the emergency department

Acute cardiogenic pulmonary oedema: reflecting on the management of an intensive care unit patient

“…On admission to ICU, Mrs Smyth was conscious but clearly in respiratory distress with symptoms of breathlessness, tachypnoea, wheeze, cyanosis, tachycardia and she was sweaty, pale, cold and clearly anxious. All these symptoms are common for patients in heart failure with APO (Kelly, 1999; Ekman et al , 2007; Collins et al , 2008). The first priority was to support Mrs Smyth's airway and breathing.…”

“…However, eventually when there is a backflow of blood into the pulmonary circulation, the hydrostatic pressures rise and eventually exceed the osmotic pressure causing fluid to move into the interstitial spaces leading to pulmonary oedema (Bucher and Melander, 1999). As fluid accumulates in the alveoli, some collapse, some are compressed by surrounding oedematous alveoli and others cannot function as the airways are full of fluid (Kelly, 1999). Blood that flows past oedematous alveoli cannot pick up as much oxygen as normal and hypoxaemia occurs (Kelly, 1999).…”

“…As fluid accumulates in the alveoli, some collapse, some are compressed by surrounding oedematous alveoli and others cannot function as the airways are full of fluid (Kelly, 1999). Blood that flows past oedematous alveoli cannot pick up as much oxygen as normal and hypoxaemia occurs (Kelly, 1999). The decreased lung compliance and the resistance within the airways makes it very difficult for the lungs to open and the patient has to work incredibly hard to initiate inspiration and get air into the lungs (McCance and Heuther, 2006).…”

“…Surprisingly, heart failure has a worse prognosis than most cancers (Nicholas, 2004). Standard therapy is largely supportive and treatment is aimed at promoting gaseous exchange, reducing the heart's oxygen demand and reducing fluid overload (Kelly, 1999). With the prognosis already so poor for these patients, it is essential therefore that the treatment they do receive is as efficacious as possible so that they are given every chance possible to survive.…”