Therapy

Therapy is divided into immediate measures, which should lead to a rapid relief of symptoms and complaints, and causal therapy, which should eliminate the original problem that caused water in the lungs. In any case, it is important to be admitted to a hospital, as medical assistance must be guaranteed in all cases. Immediate measures include a sitting position of the patient, with the legs being positioned low (hanging legs).

This reduces the hydrostatic pressure in the vessels, especially the pulmonary arteries, which should reduce the transfer of fluid into the tissue. It is also important to calm the patient and possibly remove tight clothing and other measures that make breathing easier. Sedatives such as morphine or diazepam can be administered to relieve pain and calm the patient.

However, this should not be taken if there is respiratory depression (too slow and inadequate breathing). In addition, oxygen is supplied to the patient via a nasal probe. At the same time, secretion and fluid should be aspirated via a tube to improve the situation acutely and make breathing easier.

In severe cases, the patient may have to be temporarily given artificial respiration. The choice of causal therapy depends on the cause of the disease. If the water in the lungs was caused by a cardiac cause, i.e. cardiac insufficiency, drugs must be given to reduce the load on the heart.These include nitroglycerin or diuretics, for example furosemide.

The latter promote water excretion by the kidneys, which reduces the volume in the bloodstream and relieves the heart. If the kidneys are weak and the blood volume and load are too high, dialysis (“blood washing”) is indicated. If the trigger is toxins or an allergy, corticosteroids are often administered.

Dialysis is an invasive procedure, which is mainly used in patients with renal insufficiency to “wash” the entire blood volume once. Dialysis machines can also be programmed to remove water from the body in order to relieve edema in various parts of the body. However, since only the total volume of fluid is reduced during dialysis therapy and water is not specifically removed at a certain point, it can happen that edema does not recede sufficiently despite dialysis.

If this is the case, one should wait for several dialysis sessions and give the body time to redistribute the fluid volume. In addition, drug therapy for drainage should be considered and a restriction on the amount of fluid that can be drunk should be established. If the water is only present in the lung gap, a puncture can be performed to relieve the pressure.

If water has entered the lung or the pleural gap, there are numerous measures to get it out of there. For one thing, the triggering cause that has led to water in the lungs must be switched off. On the other hand, one can try to increase the urine production with flushing medication (diuretics).

In this way, more water is simultaneously transported out of the body. If this treatment is carried out for a few days, the water in the lungs will slowly decrease. The washed out drugs can be given to the patient by infusion (especially if there is a large amount of water in the lungs) or by tablets (especially if there is a small amount of water).

If these measures are not sufficient and more and more water enters the lungs or pleural gap, further and above all invasive measures must be taken to prevent the increasing over-watering of the lungs. If fluid collects in the pleural gap, a small needle can be used to access the pleural gap. The liquid then runs out of the gap and can be collected.

This is also called pleural puncture. The area to be punctured is first disinfected and the surrounding area sterilely covered. The pleural effusion is detected by means of an ultrasound device and the access is then placed at this site.

This remains in place until enough fluid has drained off. If there is no more fluid in the pleural gap, the patient usually begins to cough. The success is confirmed by an X-ray. If not enough water has drained off, it may be necessary to repeat this puncture.