neurogenic pulmonary edema

QUICK PEARLS:

WHAT IS IT?

increase in pulmonary interstitial & alveolar fluid, developing rapidly after acute CNS injury (e.g. seizure, trauma, cerebral hemorrhage)

shares characteristics of ARDS (acute respiratory distress syndrome)

 

SYMPTOMS/FINDINGS include:

• dyspnea
• mild hemoptysis (maybe)
• tachypnea
• tachycardia
• basilar rales/pulmonary edema
• normal heart size

 

PATHOPHYS?

“remains incompletely understood” (awesome)

usually associated with elevated ICP, but elevated ICP is not necessary to have neurogenic pulm edema

theories include:

• medulla oblongata mediated – sympathetic surge
• pulmonary venoconstriction
• increased pulm capillary permeability, by secondary mediators (e.g. histamine, bradykinin) or microvascular injury from high pressure surge

,

INTERESTING TIDBITS:

• alpha adrenergic blockage (e.g. phentolamine) can prevent NPE (animal models).  so can spinal cord transection at/above C7, & denervation of sympathetic fibers to lungs.

 

TREATMENT:

supportive care (ABC’s)

treat the underlying disorder

majority resolve in 2-3 days

data for meds (e.g. phentolamine) is limited, and NPE should resolve anyways, so hard to read into results — proceed with caution

supportive care (ABC’s)

 

References: uptodate.com: neurogenic pulmonary edema; picture

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