Neurogenic pulmonary edema after severe head injury: a transpulmonary thermodilution study

Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiolo...

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Bibliographic Details
Published in:The American journal of emergency medicine 2015-06, Vol.33 (6), p.858.e1-858.e3
Main Authors: Chaari, Anis, MD, Chtara, Kamilia, MD, Toumi, Nozha, Bahloul, Mabrouk, MD, Bouaziz, Mounir, MD
Format: Article
Language:English
Subjects:
Blood pressure
Catheters
Craniocerebral Trauma - complications
Craniocerebral Trauma - surgery
Diagnostic Imaging
Edema
Emergency
Emergency medical care
Extravascular Lung Water
Fatal Outcome
Glasgow Coma Scale
Head injuries
Heart rate
Hematoma - etiology
Hematoma - surgery
Humans
Intensive care
Male
Middle Aged
Mortality
Nervous system
Permeability
Pulmonary arteries
Pulmonary Edema - diagnosis
Pulmonary Edema - etiology
Respiratory distress syndrome
Thermodilution
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Summary:Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index. The impairment of the left ventricular function was confirmed by the echocardiographic study. Our case suggests that NPE imply both cardiac dysfunction and lung injury. Thus, transpulmonary thermodilution can be helpful in managing fluid balance and the choice of vasopressors in patients with life-threatening NPE.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2014.12.009