Why fluid accumulates in the lungs: the doctor answers

Lung tissue contains a large number of tiny sacs called alveoli. Gas exchange, the actual process of respiration, occurs in them.

Our expert in this field:

Sergeev Pyotr Sergeevich

Oncologist, surgeon, chemotherapist, Ph.D. Member of the international society of surgical oncologists EESG

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The outside of the lungs is covered with a thin film - the pulmonary pleura. They are located in the chest, the surface of which is also lined by the pleura, it is called the parietal. There is a small gap between the two layers of pleura, it is called the pleural cavity.

Fluid can accumulate both in the alveoli of the lungs and in the pleural cavity. In the first case it is pulmonary edema, in the second case it is hydrothorax.

The accumulation of fluid in the lungs can occur rapidly, have an acute form, or increase and progress over a long time.

Oncological causes

The cause of pulmonary edema or hydrothorax in cancer patients can be both the cancer itself and its treatment.

For example, fluid accumulation and pulmonary edema can occur as a result of chemotherapy with toxic drugs that depress the heart, or as a complication of radiation therapy. On the other hand, the functioning of the heart can be disrupted by the tumor process.

Another possible reason is disruption of the lymphatic system due to damage to the lymph nodes by metastases or germination of a cancerous tumor.

Most often, fluid accumulation occurs in cancer of the lung, breast, ovary, stomach, body and cervix, melanoma, lymphoma, sarcoma, and leukemia.

With a malignant tumor of the pleura (mesothelioma), the permeability of the vascular wall of the capillaries increases. Fluid from the blood actively enters the lungs, and its pumping by the lymphatic system, on the contrary, worsens. As a result, stagnation and fluid accumulation occurs.

Other reasons are also possible, for example, compression of the heart by a tumor, tumor growth into the superior vena cava, formation of metastasis in the pericardium, tumor growth into the lumen of the bronchus and its overlap.

Oncological diseases are characterized by a gradual, slow development of hydrothorax and pulmonary edema.

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Consequences of pulmonary edema in the elderly

Pulmonary edema syndrome is dangerous because various complications often develop after it:

• a secondary infection may occur, which can lead to pneumonia, which, in combination with edema, is very difficult to treat;
• The lack of oxygen that accompanies pulmonary edema has a detrimental effect on the functioning of internal organs, especially the brain and heart. The consequences of such exposure can be irreversible and lead to human death;
• development of pneumofibrosis and segmental atelectasis.

The recovery period depends on the underlying disease, the general condition of the body, the patient’s age and other factors. Treatment lasts on average from a week to a month.

If there are no complications and quality medical care is provided, then after ten days the patient will be able to go home.

Toxic pulmonary edema is considered the most complex and prone to recurrence. Patients with this diagnosis spend at least three weeks in the hospital.

But regardless of the causes of pulmonary edema, the disease is considered very serious. In acute alveolar edema, the mortality rate is 20–50%. If swelling accompanies myocardial infarction or anaphylactic shock, the patient dies in 90% of cases.

Even with the timely provision of qualified medical care, there is a high probability of complications such as ischemic damage to the viscera, pneumonia, pulmonary atherosclerosis, etc. If the underlying disease was eliminated in a timely manner, then there is still a risk of resumption of pulmonary edema. In any case, the earlier treatment is started, the greater the chance of survival.

Non-cancer reasons

From the bronchi, through their branches, bronchioles, air enters the alveoli of the lungs. On the other hand, they are surrounded by capillary vessels that have a thin wall. Through it, carbon dioxide is released from the blood into the alveoli, and oxygen enters the blood.

A common cause of fluid accumulation in the lungs is heart failure and high blood pressure (hypertension), which “squeezes” fluid through the vascular wall into the alveolar cavity. In turn, heart failure can be a consequence of a heart attack.

Other possible causes are liver disease (cirrhosis), kidney disease (renal failure), bronchial asthma, diabetes mellitus, pneumonia, tuberculosis, pleurisy, trauma, pulmonary contusion, thromboembolism, intoxication.

The kidneys are responsible for removing fluid from the body. When their work is disrupted, edema occurs and fluid accumulates in different parts of the body, including the lungs.

Health care

Emergency therapy includes the following procedures:

1. Using an oxygen mask (oxygenation). If the case is urgent, then the supply of oxygen through a mask is replaced by artificial ventilation.
2. The patient is given morphine as a pain reliever and sedative.
3. Aminophylline is also introduced, which helps remove excess sodium from the body, dilate the bronchi and improve blood circulation in the renal glands.
4. At the same time, doctors monitor the patient's blood pressure. If it exceeds the norm, then the patient is injected with sodium nitroprusside, and if the blood pressure is too low, then dobutamine is injected.

Further therapy includes taking medications. The doctor may prescribe:

• hormonal drugs;
• antibiotics;
• hepatoprotectors;
• antihistamines.

Symptoms

One of the most characteristic symptoms of fluid accumulation in the lungs is shortness of breath. First it occurs during physical activity, then at rest.

Shortness of breath is accompanied by a feeling of lack of air, rapid breathing, suffocation, weakness, fear of death, a feeling of incomplete expansion of the lungs when breathing, and insufficient filling of them with air.

Symptoms usually worsen when lying down. An acute attack of suffocation can cause death.

Insufficient breathing leads to oxygen starvation, hypoxia - pale and blue skin (cyanosis), dizziness, darkening of the eyes, fainting, and headaches.

The nervous system, brain, and psyche suffer from insufficient breathing; restlessness, nervousness, anxiety, and numbness in the arms or legs appear.

Due to the accumulated fluid, body weight increases. Depending on the presence or absence of an inflammatory process, body temperature may be increased or decreased.

Low body temperature is a specific sign of fluid accumulation in the lungs.

Other symptoms are pain in the lung (usually at the bottom or side), persistent, hacking dry cough with the release of viscous mucus with ichor, a feeling of constriction, heaviness in the chest, sweating (especially at night)

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Complications

The main thing that threatens pulmonary edema in an elderly person is the lack of oxygen in the tissues. Even if the disease has been stopped, the brain will experience serious changes, and the tissues of the heart and lungs will suffer.

Also among other serious consequences of suffering from pulmonary edema are:

• formation of congestion in the lungs;
• organ ischemia;
• emphysema.

Due to oxygen starvation, the patient’s memory will deteriorate, during the daytime he will constantly feel sleepy, general lethargy will be felt, and his mood will begin to deteriorate. You will have to carefully monitor your own condition in order to notice serious deterioration in time and consult a doctor.

Pulmonary edema in old age is a serious pathology. Even if the disease manifests itself in a protracted or subacute form, the risk of complications after therapy is high. An immediate or acute syndrome practically does not allow saving the patient. So at the first symptoms indicating the development of the disease, you need to undergo an examination and consult a doctor so that it is not too late.

Diagnostics

At the initial appointment, the doctor conducts an examination (when breathing, the right or left side of the chest may be delayed), taps, and listens to the patient with a phonendoscope.

The purpose of diagnostic studies is to establish not only the fact and severity of pulmonary edema and/or hydrothorax, but also its cause.

A biochemical blood test, an analysis of the content of gases in the blood, and coagulation help to do this.

Using an X-ray, you can clearly see the accumulation of fluid, estimate its volume, detect a tumor, and damage to the lymph nodes.

More detailed, additional information is provided by computer and magnetic resonance imaging (CT, MRI), ultrasound of the chest.

To confirm or exclude cancer, a puncture or biopsy is performed, followed by a morphological examination (cytological, histological). In the first case, fluid is taken from the pleural cavity, in the second, a fragment of pleural tissue is taken.

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How to give first aid

First aid to a patient who has pulmonary edema should be provided by those around him:

1. First of all, make the victim sit comfortably, his legs should hang over the seat. This will help reduce the amount of blood entering the pulmonary circle.
2. In some cases, the patient can be given medications. For example, if the swelling was caused by heart disease, then it is necessary to put nitroglycerin under the victim’s tongue. Diuretics that reduce venous return (eg, Furosemide) may also help. This medicine is administered intravenously, but the dosage is selected only by a doctor.
3. Next, to reduce venous return, you need to apply a cuff to your leg or arm. This will partially compress the veins, leaving only a small flow of air under the pressure cuff. It is especially useful for pulmonary edema in bedridden elderly patients.
4. Before the ambulance arrives, the patient should be given sedatives (Relanium is excellent). During this procedure, the amount of catecholamines in the bloodstream will decrease, and the venous flow of blood to the heart muscle will also decrease.
5. If the patient suddenly begins to foam, then you need to moisten a cotton swab in medical alcohol and let the patient smell it. By inhaling ethyl alcohol vapor for ten minutes, the patient will be able to hold out until the ambulance arrives. However, sometimes the reaction to alcohol vapor can be completely unexpected - instead of relief, the patient may feel that he does not have enough air. In this case, the tampon should be immediately removed from the nose.

Treatment

If the cause of fluid accumulation is not cancer, drug therapy is used with diuretics (diuretics), cardiac drugs, anti-inflammatory drugs, antibiotics, bronchodilators, expectorants and other drugs as indicated.

For malignant tumors, the use of such drugs may be symptomatic, or they are used to treat concomitant diseases. The main treatments used are chemotherapy or surgery.

1. Thoracentesis – pumping out fluid from the pleural cavity. A puncture is made in the chest wall with a thin needle, after which the effusion is pumped out through a tube using an electric suction.

   The procedure is performed under local anesthesia. It gives a quick effect, relieves the condition, but after some time the fluid accumulates again, hydrothorax resumes, and this requires repeat thoracentesis.

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   To avoid repeated punctures of the chest wall, a port system is installed in it, connected by a drainage tube to the pleural cavity. When fluid accumulates, the port opens and the effusion is pumped out using an electric suction device.

   The intrapleural port system allows not only to pump out accumulated fluid, but also to inject drugs into the pleural cavity.

2. Pleurodesis - introduction into the pleural cavity of sclerosing substances that glue the thoracic and parietal pleura. After this, the liquid has nowhere to accumulate. Pleurodesis is usually performed after draining the effusion (thoracentesis).

   In case of oncological diseases, chemotherapy drugs are used for pleurodesis, which have a cytostatic effect and at the same time glue the pleural lobes together.

   Along with cytostatics, the international clinic Medica24 uses immunomodulators that destroy cancer cells and show very good results of pleurodesis.

3. Removal of pleura for oncological diseases in our clinic, as a rule, it is performed laparoscopically, through minimally invasive surgery.

   A thoracoscope with a video camera and surgical instruments are inserted through the punctures. This allows you to avoid incisions and reduce traumatic effects.

The material was prepared by oncologist, thoraco-abdominal surgeon of the International Clinic Medica24 Alexander Valerievich Korotaev.

Prevention of pulmonary edema in the elderly

Prevention of pulmonary edema in older people includes timely treatment of the underlying disease. You need to be constantly monitored by medical specialists, not to come into contact with harmful substances and toxins, not to abuse alcohol and overeating, follow the instructions for using medications, and lead a healthy lifestyle.

If a person has chronic diseases or suffers from hypertension, then you need to regularly visit the doctor and follow all his prescriptions. Secondary, but no less important, measures to prevent pulmonary edema in older people are: a positive attitude, proper nutrition and an active lifestyle.

It is impossible to predict when an attack will occur, but you can reduce the likelihood of it occurring. You also need to remember that timely medical care is the key to saving lives.

To reduce the risk of pulmonary edema in bedridden elderly people, they need to purchase an orthopedic mattress. Even such, at first glance, a trifle can prevent the development of congestive pneumonia.

The patient will need a varied diet high in vitamins, breathing exercises and therapeutic massage.

The air in the room must be humid. This is important to prevent the occurrence of pneumonia. To increase humidity, you can use a special device or ventilate the room in rainy weather.

You need to constantly listen to the breathing of a person confined to bed. It should be smooth and clean, without gurgling or wheezing. If extraneous sounds appear, you must urgently call an ambulance.

For heart failure

In heart failure, systemic circulation becomes significantly more difficult. Insufficient blood flows to the alveoli, they become inflamed. When turning into an acute form, water and oxygen form abundant foam.

Pneumonia develops due to heart pathologies. If therapy is absent or begins untimely, swelling continues to increase.

The condition manifests itself in a chronic form and is protracted. Symptoms may be erased. The doctor does not immediately understand whether the underlying cause is respiratory or heart failure.

To identify the damaging factor, a comprehensive examination is required. General clinical tests of biological fluids (blood, urine, leukocyte formula, coagulogram), ultrasound, MRI, CT, radiography are prescribed.

ethnoscience

You can treat effusion at home only if there is a small amount of it (as determined by x-ray), mild symptoms, and after consultation with your doctor. You can get rid of effusion in the lungs using folk remedies after eliminating the causative factor - the underlying disease that led to the complication.

To remove excess water, take 1 tbsp. spoons of parsley decoction: 500 g of fresh parsley pour 700 ml of milk, bring to a boil, cool. To speed up the process of removing phlegm, drink honey tincture. Compound:

• 200 g of dried or fresh viburnum berries;
• linden flowers, knotweed, plantain - 2 tbsp. spoons;
• coltsfoot - 1-3 sheets;
• vodka – 500 ml;
• honey – 50 ml.

Herbs and berries are poured with vodka, honey is added, stirred until the honey dissolves. Leave for 2 days in a dark place. Take 1 tbsp. spoons 3 times a day until sputum stops coming out. To get rid of a dry cough, stop an attack of bronchitis, and reduce the severity of inflammatory processes in the lungs, take anise decoction. Compound:

• flax seeds - 1 tbsp. l;
• boiling water – 200 ml;
• cognac – 1 tbsp. l;
• honey - 1 tbsp. l.

Pour boiling water over the seeds, cook over low heat for 10 minutes, cover with a lid to infuse for 15 minutes. Take 4 times a day, 1 tbsp. spoon. To strengthen the immune system and speed up the discharge of sputum, take onion juice once a day, 1 tbsp. l: one finely chopped onion sprinkled with 1-2 tbsp. l. sugar, after 10-15 minutes squeeze the juice through cheesecloth.

Important! Traditional methods of treatment can be combined with drug therapy.

Contraindications to pleurodesis

• Pathological conditions that prevent the expansion of the lung. For example, it could be congestive lung - stagnation of blood in the pulmonary veins.
• Insufficient drainage. Before performing pleurodesis, fluid must be removed from the pleural cavity.
• Recent chest radiation therapy and chest tube placement for more than 10 days reduce the likelihood that pleurodesis will be performed successfully.
• An assessment of the patient's condition according to the Karnofsky index of less than 50% and a body mass index of less than 25 kg/m2 are also risk factors for unsuccessful pleurodesis.
• Infectious process in the pleura.
• Discharge of more than 150 ml of fluid through the drainage tube. The optimal situation for pleurodesis is the release of no more than 100 ml of fluid during the last 24 hours.
• The patient's categorical refusal to undergo the procedure.
• The patient's life expectancy is less than three months. In such cases, to alleviate the patient's condition, thoracentesis is periodically performed.

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