Acute Pulmonary Edema in Healthy Subjects

INTRODUCTION: Healthy individuals may present with acute pulmonary edema when exposed to extreme environments (high-altitude or deep diving) or while performing strenuous exercises. Recent data support the hypothesis that these forms of acute pulmonary edema might be due to a limited number of stimuli, often overlapping each other, inducing pulmonary capillary stress failure.DISCUSSION: Pathophysiology of nontoxic pulmonary edema occurring in healthy people is still incompletely understood, but recent data suggest a role of three factors (hypoxia, increase in ambient pressure, and physical exercise) that, alone or in combination, may increase pulmonary capillary pressure up to a level overcoming the mechanical resistance of the blood-gas barrier. Evidence has been recently provided to support the existence of a genetic pattern predisposing healthy subjects to pulmonary edema. This paper reviews the evidence supporting a common background for pulmonary edema triggered by extreme environments or heavy effort; a preventive and therapeutic strategy will also be proposed. From these data, hypotheses on the pathophysiology of other forms of noncardiac related pulmonary edema, as those associated with obstructive sleep-apnea syndrome or during post-surgery intensive care, will be proposed.Marabotti C, Cialoni D, Pingitore A.