Send to

Choose Destination
J Cardiothorac Vasc Anesth. 2018 Apr;32(2):901-914. doi: 10.1053/j.jvca.2017.08.028. Epub 2017 Aug 19.

Assessment of Pulmonary Edema: Principles and Practice.

Author information

Cardiothoracic Anesthesia Service, VA Connecticut Healthcare System, Yale University School of Medicine, New Haven, CT. Electronic address:
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA.
Golden Jubilee National Hospital /West of Scotland Heart and Lung Centre, University of Glasgow, Glasgow, Scotland.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, VA Connecticut Healthcare System, New Haven, CT.
Cardiothoracic Anesthesia Service, VA Connecticut Healthcare System, Yale University School of Medicine, New Haven, CT.


Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred. The ideal properties of such a tool would include high sensitivity and specificity, easy availability, and the ability to diagnose early accumulation of lung water before the development of the full clinical presentation. In addition, clinicians highly value the ability to precisely quantify extravascular lung water accumulation and differentiate hydrostatic from high permeability etiologies of pulmonary edema. In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored.


auscultation; chest radiography; lung ultrasound; pulmonary edema; transpulmonary thermodilution


Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center