Pathogenesis of pulmonary edema: learning from high-altitude pulmonary edema

Sartori, Claudio; Allemann, Yves; Scherrer, Urs (2007). Pathogenesis of pulmonary edema: learning from high-altitude pulmonary edema. Respiratory physiology & neurobiology, 159(3), pp. 338-49. Kidlington, UK: Elsevier 10.1016/j.resp.2007.04.006

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Pulmonary edema is a problem of major clinical importance resulting from a persistent imbalance between forces that drive water into the airspace of the lung and the biological mechanisms for its removal. Here, we will review the fundamental mechanisms implicated in the regulation of alveolar fluid homeostasis. We will then describe the perturbations of pulmonary fluid homeostasis implicated in the pathogenesis of pulmonary edema in conditions associated with increased pulmonary capillary pressure, namely cardiogenic pulmonary edema and high-altitude pulmonary edema (HAPE), with particular emphasis on the latter that has provided important new insight into underlying mechanisms of pulmonary edema. We will provide evidence that impaired pulmonary endothelial and epithelial nitric oxide synthesis and/or bioavailability may represent a central underlying defect predisposing to exaggerated hypoxic pulmonary vasoconstriction, and, in turn, capillary stress failure and alveolar fluid flooding. We will then demonstrate that exaggerated pulmonary hypertension, while possibly a prerequisite, may not always be sufficient to cause HAPE, and how defective alveolar fluid clearance may represent a second important pathogenic mechanism. Finally, we will outline, how this new insight gained from studies in HAPE, may be translated into the management of pulmonary edema and hypoxemia related disease states in general.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Allemann, Yves

ISSN:

1569-9048

ISBN:

17532272

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:54

Last Modified:

04 May 2014 23:16

Publisher DOI:

10.1016/j.resp.2007.04.006

PubMed ID:

17532272

Web of Science ID:

000251827000011

URI:

https://boris.unibe.ch/id/eprint/23210 (FactScience: 40596)

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