Editor's Perspective

Acute pulmonary edema is a common medical emergency encountered frequently in all hospitals that deal with seriously ill patients. Acute pulmonary edema may occur on any ward in the hospital, in the intensive care unit, or present to the emergency room. It is clear that acute pulmonary edema is the final common pathway of a variety of processes well described by Dr. Brigham's group in this issue of Seminars. Common denominators include increased hydrostatic forces and alterations in permeability of the so-called alveolar capillary membrane. The final result is lung leak and at least some degree of flooding of gas exchange units of the lung. The presence of acute pulmonary edema is not difficult to recognize. Understanding the basic mechanisms underlying the development of the acute pulmonary edema is fundamental to organizing specific, physiologically oriented therapy. if the primary problem is hemodynamic, that is, a problem incident to events of the left side of the heartsuch as in ischemic heart disease with impaired cardiac output or valvular diseasea specific diagnosis can usually be made on the basis of history, physical examination, and both noninvasive and invasive assessments of cardiac function. if the problem encountered at the bedside is one of fluid overload, acting either alone or in combination with a degree of cardiac dysfunction, this fact can usually be established by a careful review of antecedent events, including the details of fluid administration. Thus, when the problem is primarily hydrostatic pulmonary edema, therapeutic approaches focus on correction of the underlying problem, employing diuretics, afterload reduction of the left ventricle, use of mo tropic agents, appropriate fluid restriction and supportive care with oxygen. In desperate situations, aortic balloon assist Editor's Perspective