Chart — Pulmonary Diseases
ARDS vs Cardiogenic Pulmonary Edema Chart
Both fill the alveoli with fluid and both present as bilateral infiltrates with hypoxemia — but one is a leaky-membrane problem and the other is a pressure problem, and they are managed in opposite directions. This chart contrasts the two so you can tell a permeability edema from a hydrostatic one at the bedside.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
ARDS vs Cardiogenic Edema Side by Side
| Feature | ARDS (non-cardiogenic) | Cardiogenic Edema |
|---|---|---|
| Mechanism | Increased capillary permeability / diffuse alveolar damage | Hydrostatic — elevated left atrial pressure |
| Onset | Within 1 week of an insult — sepsis, aspiration, pancreatitis, trauma | Acute cardiac event or fluid overload |
| Chest X-ray | Bilateral patchy infiltrates, often peripheral | Central / perihilar “bat-wing,” cephalization, effusions, cardiomegaly |
| Heart size | Normal | Often enlarged |
| BNP | Lower | Typically elevated |
| Echo / EF | Preserved unless coexisting disease | Often reduced EF or diastolic dysfunction |
| Edema fluid protein | High — exudate | Low — transudate |
| P/F ratio | ≤ 300 with PEEP ≥ 5 defines severity | Hypoxemia improves with diuresis / afterload reduction |
| Response to diuresis | Minimal | Improves |
| Management | Lung-protective ventilation, treat the cause, prone if severe | Diuretics, preload / afterload reduction, CPAP/NIV, treat the cardiac cause |
Clinical Notes
- The two can coexist. A septic patient with ARDS can also be volume-overloaded; the presence of one does not rule out the other.
- Read the P/F in context. The Berlin severity bands assume a PEEP of at least 5 cm H₂O, so always pair the P/F ratio with the PEEP it was measured on. Run the numbers with the P/F ratio calculator.
- Let the whole picture decide. No single value is definitive — the clinical context, echocardiogram, and BNP together distinguish a permeability edema from a hydrostatic one.
Related Resources
Sources
- ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-2533.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.