Prospective evaluation of pulmonary edema

Crit Care Med. 2000 Feb;28(2):330-5. doi: 10.1097/00003246-200002000-00007.


Objectives: To describe the clinical profile and hospital outcome of successive unselected patients with pulmonary edema hospitalized in an internal medicine department.

Design: Prospective, consecutive, unsolicited patients diagnosed with pulmonary edema.

Setting: An internal medicine department in a 900 tertiary care center.

Patients: A total of 150 consecutive unselected patients (90 males, 60 females; median age, 75 yrs).

Results: Ischemic heart disease, hypertension, various valvular lesions and diabetes mellitus were present in 85%, 70%, 53%, and 52% of patients, respectively. Acute myocardial infarction at admission was observed in 15% of patients. The most common precipitating factors associated with the development of pulmonary edema included: high blood pressure (29%), rapid atrial fibrillation (29%,) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%). Twenty-two patients (15%) were mechanically ventilated. Eighteen patients (12%) died while in the hospital, and the cause of death was cardiac pump failure in 82%. The median hospital stay was 10 days. Predictors for increase rate of in-hospital mortality included: diabetes (p<.05), orthopnea (p<.05), echocardiographic finding of moderate-to-severely depressed global left ventricular systolic function (p<.001), acute myocardial infarction during hospital stay (p<.001), hypotension/shock (p<.05), and the need for mechanical ventilation (p<.001).

Conclusions: Most patients with pulmonary edema in the internal medicine department are elderly, having ischemic heart disease, hypertension, diabetes, and a previous history of pulmonary edema. The overall mortality is high (in-hospital, 12%) and the predictors associated with high in-hospital mortality are related to left ventricular myocardial function. The long median hospital stay (10 days) and the need for many cardiovascular drugs, impose a considerable cost in the management and health care of these patients.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Causality
  • Cause of Death
  • Diabetes Complications
  • Female
  • Heart Diseases / complications
  • Hospital Mortality
  • Humans
  • Infections / complications
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Pulmonary Edema / diagnosis
  • Pulmonary Edema / etiology*
  • Pulmonary Edema / mortality*
  • Pulmonary Edema / therapy
  • Respiration, Artificial
  • Treatment Outcome