Good pathophysio paper and differential diagnosis for non cardiogenic pulmonary edema

Noncardiogenic pulmonary edema in small animals

Karin Unger DVM Linda G. Martin MS, DACVECC

Background
Noncardiogenic pulmonary edema (NCPE) is characterized by abnormal fluid accumulation in the lungs due to mechanisms other than cardiac dysfunction or fluid overload. Common causes include increased vascular permeability, altered hydrostatic pressure, or a combination thereof. Specific etiologies include acute respiratory distress syndrome (ARDS), neurogenic pulmonary edema (NPE), post-obstructive pulmonary edema (POPE), electrocution, re-expansion pulmonary edema (RPE), and drug-induced or drowning-associated NCPE.

Methods
This clinical practice review synthesizes existing veterinary and human literature on NCPE, focusing on the underlying pathophysiology, diagnostic criteria, and management strategies. A range of imaging techniques, clinical observations, and experimental data inform the understanding of these conditions.

Results
Acute Respiratory Distress Syndrome (ARDS): ARDS has a prevalence of 3.2% in ICU dogs and 1.3% in ICU cats, often secondary to aspiration pneumonia or sepsis. Mortality rates are high (84–92% in dogs, 80–100% in cats).

Neurogenic Pulmonary Edema (NPE): Frequently associated with trauma or seizures, NPE generally has a good prognosis, resolving within days.
Electrocution-Induced NCPE: Young animals (under 1 year) are most commonly affected. Prognosis varies but is often favorable.

Post-Obstructive Pulmonary Edema (POPE): Caused by airway obstruction; prognosis depends on severity but can be fatal in 34–50% of cases.
Re-expansion Pulmonary Edema (RPE): Rare but potentially fatal, RPE often follows lung re-expansion after collapse due to conditions like pneumothorax.

Drowning-Associated NCPE: Frequently results in ARDS, with an overall mortality rate of 36% in canine and feline victims.

Drug-Induced NCPE: Rare in veterinary cases but documented with chemotherapeutic agents and certain toxic exposures.

Limitations
There is limited data for many specific etiologies of NCPE in veterinary medicine, particularly in cats. Diagnostic criteria and imaging techniques may not always align with available resources in clinical settings. Most studies rely on retrospective or case-report data, limiting generalizability.

Conclusions
NCPE encompasses diverse etiologies requiring prompt recognition and supportive care, such as oxygen therapy and mechanical ventilation in severe cases. High-flow oxygen therapy (HFOT) shows promise as a less invasive alternative for hypoxemic patients. Improved understanding of disease mechanisms and risk factors may enhance outcomes.

Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.