Pulmonary edema

Pulmonary edema refers to the buildup of fluid in the lungs including the airways like the alveoli - which are the tiny air sacs - as well as in the interstitium, which is the lung tissue that’s sandwiched between the alveoli and the capillaries.

This space is mostly full of proteins, and when it starts filling up with fluid, it can make it hard for oxygen to cross over from the alveoli into the capillary, leaving the body hypoxic - or deprived of oxygen.

To understand pulmonary edema, let’s first talk about the three main factors that determine how fluid moves between the capillaries and interstitial fluid, which are the hydrostatic pressure, oncotic pressure and capillary permeability.

Hydrostatic pressure refers to the pressure felt by fluid in a confined space, pushing the fluid out of that space.

In the interstitial space, it’s the same thing as the blood pressure in the pulmonary capillaries, and because the pulmonary circulation is a low pressure system, the hydrostatic pressure is pretty low. But it’s still higher than the hydrostatic pressure exerted by the interstitial fluid of the lungs - which is almost zero.

So, to be clear, if hydrostatic pressure was the only factor involved, a lot of fluid would be continuously leaking out of the pulmonary capillaries into the lung’s interstitial space.

The next factor, though, is oncotic pressure; which is a type of osmotic pressure exerted by cells and proteins that can’t cross the capillary membrane and therefore tend to attract fluid.

The oncotic pressure is higher in the pulmonary capillaries than in the interstitial fluid, so it opposes the hydrostatic pressure.

Finally, there’s capillary permeability or leakiness which affects how easily fluid is actually able to get through.

When taking these three factors together, the net result is that a very small amount of fluid leaks into the interstitial space, and that fluid is normally whisked away by the lymphatic channels in the lungs, which keeps the lungs free of excess fluid.

Now, the underlying cause of pulmonary edema can be cardiogenic - meaning that it develops as a result of a heart disease, or can be non-cardiogenic which typically involves damage to the pulmonary capillaries or alveoli.