IngentaConnect Neurogenic pulmonary edema

Authors: Baumann¹; Audibert¹; McDonnell¹; Mertes

Source: Acta Anaesthesiologica Scandinavica, Volume 51, Number 4, April 2007 , pp. 447-455(9)

Abstract:

Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects.

NPE seems to be under-diagnosed in acute neurologic injuries, partly because the prevention and detection of non-neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased P_ao₂/F_io₂ ratio.

The associated mortality rate is high, but recovery is usually rapid with early and appropriate management.

The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction.

During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.

Keywords: acute pulmonary edema; brain injury complications; central nervous system injury; neurogenic lesions; neurogenic pulmonary edema

Document Type: Research article

DOI: 10.1111/j.1399-6576.2007.01276.x

Affiliations: 1: Département d'Anesthésie - Réanimation, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France

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