ARDS vs Cardiogenic Pulmonary Edema: Non-Cardiac vs Cardiac Fluid in the Lungs
Both present with bilateral white-out on chest X-ray, crackles, and refractory hypoxia — but pushing furosemide on an ARDS patient depletes intravascular volume and tanks perfusion, while withholding it from cardiogenic edema lets the patient drown. The wedge pressure and BNP separate these two rapidly.
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- Leaky alveolar capillaries
- Sepsis, aspiration, pneumonia, TRALI
- Hydrostatic backup from LV failure
- Acute MI, valve disease, volume overload
- Refractory hypoxia despite high FiO₂
- Bilateral crackles
- Minimal relief sitting upright
- ★Pink frothy sputum
- Dyspnea relieved by high Fowler's
- Bilateral crackles
- ★BNP normal/low (<100)
- PAWP ≤18 (leak)
- P/F ratio ≤ 300 (Berlin)
- CXR diffuse white-out
- BNP elevated (>400)
- PAWP >18 (hydrostatic)
- CXR butterfly, cardiomegaly, Kerley B
- Prone positioning to recruit alveoli
- Closed inline suction to keep PEEP
- High Fowler's to cut venous return
- Restrict sodium and fluids
- Strict I&O and daily weights
- ★Diuretics don't fix the capillary leak
- Low TV 6 mL/kg IBW
- high PEEP
- IV furosemide — dramatic fluid clearance
- Nitroglycerin
- CPAP/BiPAP often avoids intubation
- Recovery is prolonged
- Pulmonary rehab after discharge
- Daily weights
- report ≥ 2–3 lb gain/day
- Low-sodium diet
- medication adherence
- Rising plateau pressure / barotrauma
- Hypoxia despite prone + high PEEP
- Cardiogenic shock (SBP < 90)
- Pink frothy sputum with falling SpO₂
- Mortality 35–45%
- Pulmonary fibrosis
- multi-organ failure
- Mortality 10–15%
- Recurrent decompensation
ARDS (Non-Cardiogenic)
- Leaky alveolar capillaries
- Sepsis, aspiration, pneumonia, TRALI
Cardiogenic Edema
- Hydrostatic backup from LV failure
- Acute MI, valve disease, volume overload
ARDS (Non-Cardiogenic)
- Refractory hypoxia despite high FiO₂
- Bilateral crackles
- Minimal relief sitting upright
Cardiogenic Edema
- ★Pink frothy sputum
- Dyspnea relieved by high Fowler's
- Bilateral crackles
ARDS (Non-Cardiogenic)
- ★BNP normal/low (<100)
- PAWP ≤18 (leak)
- P/F ratio ≤ 300 (Berlin)
- CXR diffuse white-out
Cardiogenic Edema
- BNP elevated (>400)
- PAWP >18 (hydrostatic)
- CXR butterfly, cardiomegaly, Kerley B
ARDS (Non-Cardiogenic)
- Prone positioning to recruit alveoli
- Closed inline suction to keep PEEP
Cardiogenic Edema
- High Fowler's to cut venous return
- Restrict sodium and fluids
- Strict I&O and daily weights
ARDS (Non-Cardiogenic)
- ★Diuretics don't fix the capillary leak
- Low TV 6 mL/kg IBW
- high PEEP
Cardiogenic Edema
- IV furosemide — dramatic fluid clearance
- Nitroglycerin
- CPAP/BiPAP often avoids intubation
ARDS (Non-Cardiogenic)
- Recovery is prolonged
- Pulmonary rehab after discharge
Cardiogenic Edema
- Daily weights
- report ≥ 2–3 lb gain/day
- Low-sodium diet
- medication adherence
ARDS (Non-Cardiogenic)
- Rising plateau pressure / barotrauma
- Hypoxia despite prone + high PEEP
Cardiogenic Edema
- Cardiogenic shock (SBP < 90)
- Pink frothy sputum with falling SpO₂
ARDS (Non-Cardiogenic)
- Mortality 35–45%
- Pulmonary fibrosis
- multi-organ failure
Cardiogenic Edema
- Mortality 10–15%
- Recurrent decompensation
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Low BNP + low wedge = ARDS, skip the Lasix. High BNP + high wedge = cardiac, push the Lasix.
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