Neurogenic Pulmonary Edema Follow-up
- Author: Tej K Naik, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP more...
Further Outpatient Care
No specific recommendations for outpatient follow up are needed for persons who have been treated for neurogenic pulmonary edema. Patients who recover should probably follow up with a physician in an outpatient setting as clinically indicated; however, no specific guidelines are available regarding the appropriate time interval following discharge from the hospital. In general, patients with neurogenic pulmonary edema do not present as outpatients and should not be treated in an outpatient setting.
Further Inpatient Care
Neurological insults severe enough to cause neurogenic pulmonary edema (NPE) always warrant admission to hospital. Most patients require close cardiac monitoring, requiring initial admission to a monitored bed. A telemetry unit or step-down unit bed may suffice for less severe cases. Intensive care admission may be required if patients develop increasingly severe hypoxemia or respiratory distress, or if invasive monitoring is required.
Inpatient & Outpatient Medications
No specific recommendations for outpatient medications are needed for neurogenic pulmonary edema. See Medical Care.
Patients with neurogenic pulmonary edema generally have multiple comorbidities that dictate the setting in which they are receiving care. Transfer between levels of acute care (ie, ICU to transitional care units, and subsequently to general medical/surgical ward) is influenced by a variety of factors. The most important of these is likely the underlying neurological insult that led to the development of pulmonary edema. Once this is managed and stabilized, further transitions between level of care are dictated by clinical circumstances. These include an ongoing need for mechanical ventilation, hemodynamic parameters, and the need for regular neurologic monitoring.
Prevention is primarily aimed at interventions that help avoid or relieve the neurological insults that subsequently lead to pulmonary edema. Current understanding is limited as to which patients are likely to develop pulmonary edema as a result of neurological injury. Given this lack of understanding, predicting who will develop pulmonary edema and determining what measures can then be undertaken to prevent its occurrence are difficult.
Complications include but are not limited to the following:
- Prolonged hypoxic respiratory failure
- Hemodynamic instability
- Nosocomial infections (ie, related to prolonged mechanical ventilation and hospitalization)
Neurogenic pulmonary edema usually is generally well tolerated by the patient, although some patients require ventilatory support. The neurogenic pulmonary edema usually resolves within 48-72 hours. Prognosis is determined more by the course of the underlying neurological problem than by the neurogenic pulmonary edema, unless significant respiratory complications develop.
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