Increased capillary permeability is the primary mechanism of alveolar fluid infiltration in NCPE.

 

1. Rule out cardiogenic edema: Use absence of physical exam findings, a normal/low BNP, and bedside echo.

2. ARDS is a common cause: Assume it in acute hypoxemic failure with bilateral infiltrates. Hunt for the trigger (sepsis, aspiration, etc.).

3. Consider rapid-onset etiologies: Neurogenic (post-seizure, SAH, TBI), negative pressure (post-extubation laryngospasm), re-expansion (after chest tube/thoracentesis), drug-related (opioids, amiodarone), infectious, and renal.

4. Ask about: high altitude (HAPE), recent transfusion, new medications, and infectious symptoms.

5. Treatment is supportive. If there is significant hypertension, consider nitrates (often high dose). Consider noninvasive ventilation if significant respiratory failure occurs. Diuretics may not be effective, and avoid over-diuresis in true NCPE.