Chronic anemia-induced acute pulmonary edema in a septic patient with bilateral lower limb burns: Importance of efficient coronary critical care nursing management

Muthulakshmi^1*, Deeparani², Ajith pillai³

¹Nursing Incharge-CCU, Kauvery Hospital, Radial Road, Chennai, Tamil Nadu

²Nursing superintendent, Kauvery Hospital, Radial Road, Chennai, Tamil Nadu

³HOD, Cardiology, Kauvery Hospital, Radial Road, Chennai, Tamil Nadu

*Correspondence

Abstract

Acute pulmonary edema is a life-threatening emergency commonly associated with cardiac dysfunction. However, severe anemia may precipitate pulmonary edema through increased cardiac workload, impaired oxygen delivery, and pulmonary vascular congestion. Critically ill septic patients with reduced cardiac reserve are particularly vulnerable. Early recognition and efficient coronary critical care nursing management play a major role in preventing respiratory deterioration and improving patient outcomes.

A 58-year-old female patient was admitted with urosepsis and bilateral lower limb burns associated with cellulitis. The patient had moderate left ventricular dysfunction with an ejection fraction of 42%. During hospitalization, progressive symptomatic anemia led to worsening respiratory distress and oxygen requirement suggestive of acute pulmonary edema. The patient remained conscious and hemodynamically stable but required oxygen support via nasal prongs. Clinical management included oxygen therapy, cautious intravenous fluid administration, iron replacement therapy with Inj. Ferric Carboxymaltose 1gm infusion, wound care management, sepsis control, and continuous respiratory monitoring. Efficient Coronary critical care nursing interventions contributed significantly to early identification of respiratory compromise and prevention of further deterioration.

Severe anemia should be recognized as a potential precipitating factor for acute pulmonary edema, especially in septic patients with impaired cardiac function. Prompt correction of anemia, cautious fluid management, multidisciplinary treatment, and vigilant critical care nursing surveillance are essential for successful clinical outcomes.

Key words: Acute pulmonary edema; Pulmonary vascular congestion

Introduction

Acute Pulmonary Edema (APE) is a medical emergency characterized by accumulation of fluid within the alveolar and interstitial spaces of the lungs, leading to severe respiratory distress and impaired oxygenation. Although cardiac dysfunction is the most common etiology, severe anemia can also precipitate pulmonary edema through compensatory hyper dynamic circulation and increased myocardial workload. In critically ill patients with sepsis, burns, infection, and reduced ventricular reserve, anemia significantly increases the risk of cardiopulmonary compromise. Reduced oxygen-carrying capacity results in increased cardiac output and pulmonary vascular congestion, ultimately precipitating respiratory failure if not recognized early. Coronary Critical Care Nurses play an essential role in identifying early respiratory deterioration, monitoring oxygenation, preventing fluid overload, and coordinating timely escalation of care. This case report highlights the successful management of anemia-induced acute pulmonary edema in a septic patient through multidisciplinary intervention and efficient Coronary Critical Care Nursing care.

Case Presentation

A 58-year-old female patient. Was admitted with complaints related to urosepsis and bilateral lower limb burns with cellulitis.

Diagnosis

Urosepsis
Bilateral lower limb burns with cellulitis

During hospitalization, the patient developed progressive symptomatic anemia associated with increasing oxygen requirement and respiratory distress suggestive of acute pulmonary edema.

Clinical Status

Glasgow Coma Scale: 15/15
Hemodynamically better with NIV SUPPORT
Self-voiding. Followed by continue bladder drain monitoring.
Oxygen support via NIV

Initially with Iron replacement therapy was initiated using INJ.Ferric Carboxymaltose 1gm. continue infusion administered 100 mL Normal saline over 30 mints With 70 drops per minutes(macro drip set) . Advised by the treating physician.

Investigations

Laboratory Findings

Date	Hb (g/dl)	Clinical Status	Oxygen therapy	Rx
Day 1	8.9 g/ dl	Dysnea	NIV	Inj.FCM
Day 2	8.1 g/dl	Dyspnea/RR HIGH	NIV	Blood Transfusion
Day 3	9.8 g/dl	Dyspnea reduced	O2 litters	-

Progressive reduction in haemoglobin levels
Elevated inflammatory markers suggestive of sepsis
Urine culture and blood culture sent for evaluation

ABG Trend

PH	7.31 mmHg
PaO2	58 mmHg
PaCo2	30 mmHg
HCo3	16 mEq /L
Lactate	4.0. mmol/L

Cardiac Assessment: Echocardiography revealed moderate left ventricular dysfunction with EF 42%

Respiratory Findings

Clinical findings were suggestive of pulmonary vascular congestion and acute pulmonary edema associated with severe anemia.

Pathophysiology

Severe anemia reduces oxygen delivery to tissues and activates compensatory physiological mechanisms including tachycardia and increased cardiac output.

Inline physiological relationship

In patients with impaired ventricular function, sustained cardiac stress increases pulmonary arterial pressure and contributes to pulmonary venous congestion and alveolar fluid accumulation, resulting in acute pulmonary edema.

Additional contributing factors in this patient included:

Sepsis-related inflammatory response
Reduced cardiac reserve
Increased metabolic demand
Intravenousfluid administration
Severe infection and burns-related stress

Treatment and Management

Medical Management

Oxygen therapy via nasal prongs
Controlled intravenous fluid administration (NS at 50 mL/hour)
Iron replacement therapy using Ferric Carboxymaltose infusion
Blood Transfusion (1 unit PRBC )
Sepsis management
Glycemic monitoring
Continuous hemodynamic assessment

Wound Management

Burn wound dressing was performed using Soframycin topical application.
Glycemic Control
Human Actrapid was discontinued based on capillary blood glucose monitoring values.

Coronary Critical Care Nursing Management

Efficient Coronary Critical Care Nursing management played a crucial role in early identification and prevention of further cardiopulmonary deterioration.

Specialized Nursing Interventions

Continuous monitoring of vital signs and oxygen saturation
Early identification of respiratory distress and worsening hypoxia
Strict intake-output monitoring to prevent fluid overload
Assessment for pulmonary congestion and breath sound changes
Monitoring hemodynamic stability in view of reduced EF
Safe administration and monitoring of iron infusion therapy
Burns wound care and infection prevention
Sepsis surveillance and early escalation of care
Continuous patient assessment and multidisciplinary coordination.

Nursing Impact on Outcome

Timely nursing surveillance enabled

Early recognition of anemia-associated respiratory compromise
Prevention of worsening pulmonary edema
Maintenance of adequate oxygenation
Guider fluid management
Prevention of sepsis-related deterioration
Improved patient stabilization

This case emphasizes the importance of evidence-based Coronary Critical Care Nursing care in improving outcomes among critically ill patients with complex cardiopulmonary complications.

Discussion

Anemia-induced pulmonary edema remains an under recognized but clinically significant condition in critically ill patients. Severe anemia increases myocardial workload and pulmonary venous pressure, especially in patients with impaired cardiac function.

The present patient had multiple high-risk factors including:

Sepsis
Burns with cellulitis
Reduced ejection fraction
Increased metabolic demand
Intravenous fluid therapy

Symptoms of anemia-induced pulmonary edema may overlap with sepsis-associated respiratory distress, leading to delayed recognition. Early ICU assessment, oxygen support, correction of anemia, cautious fluid management, and vigilant nursing monitoring are essential to prevent respiratory failure.

Coronary Critical Care Nurses contribute significantly through continuous patient surveillance, early escalation, and prevention of complications.

Outcome

Following multidisciplinary management and intensive nursing care:

Respiratory distress improved
Oxygen saturation stabilized
Hemodynamic status remained stable
Clinical recovery gradually improved
Infection control measures were continued successfully

Conclusion

Anemia-induced acute pulmonary edema is a potentially reversible but life-threatening complication in septic patients with impaired cardiac reserve. Early diagnosis, prompt correction of anemia, cautious fluid management, respiratory support, and efficient Coronary Critical Care Nursing management are essential for favourable clinical outcomes. This case highlights the vital contribution of Coronary Critical Care Nurses in early recognition, respiratory monitoring, prevention of fluid overload, and multidisciplinary critical care management.

References

Braunwald E. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine.
AACN Essentials of Critical Care Nursing.
Harrison’s Principles of Internal Medicine.
European Society of Cardiology Guidelines for Acute Heart Failure.
Journal of Critical Care Medicine.
Critical Care Nursing Clinics of North America.

Chronic anemia-induced acute pulmonary edema in a septic patient with bilateral lower limb burns: Importance of efficient coronary critical care nursing management

Chronic anemia-induced acute pulmonary edema in a septic patient with bilateral lower limb burns: Importance of efficient coronary critical care nursing management

Muthulakshmi1*, Deeparani2, Ajith pillai3

Pathophysiology

Nightingale Journals

Muthulakshmi^1*, Deeparani², Ajith pillai³