Acute Pulmonary Edema in Children: Part 1. Differentiation of Pathogenesis by Colloid Oncotic Pressure Measurement

Abstract

Because hemodynamic monitoring is not always possible or feasible in children, we sought to determine whether the ratio of the colloid oncotic pressure of pulmonary edema fluid (PEF-COP) to the colloid oncotic pressure of serum (Ser-COP) is useful in predicting the pathogenesis of pulmonary edema in children. Method: We obtained chest radiographs, pulmonary artery wedge pressure (PAWP) measurements, and samples of PEF and Ser from 18 children in respiratory failure due to acute pulmonary edema. The patients were considered to have hydrostatic (cardiogenic) pulmonary edema (HPE) if they had cardiomegaly, fine crepitant rales, and PAWP higher than 15 torr; they were considered to have increased permeability (noncardiogenic) pulmonary edema (PPE) if they had normal heart size, crackles, and PAWP less than or equal to 15 torr. We measured PEF-COP and Ser-COP via a Weil oncometer. Results: Children whose PAWP was higher than 15 torr had lower PEF-COP:Ser-COP (0.40 ± 0.12) than did children with PAWP less than 15 torr (0.95 ± 0.25). Conclusions: The data indicate that PEF-COP:Ser-COP values can be useful in differentiating between hydrostatic and permeability pulmonary edema in children, particularly when measures should be instituted to lower pulmonary vascular pressure and cardiotonic agents should be administered immediately.