Neurogenic Pulmonary Edema Follow-up

Author: Tej K Naik, MD; Chief Editor: Zab Mosenifar, MD more...

Updated: Jan 18, 2012

What would you like to print?

Further Inpatient Care
Further Outpatient Care
Inpatient & Outpatient Medications
Transfer
Deterrence/Prevention
Complications
Prognosis
Patient Education
Show All

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.

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.

Inpatient & Outpatient Medications

No specific recommendations for outpatient medications are needed for neurogenic pulmonary edema. See Medical Care.

Transfer

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.

Deterrence/Prevention

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

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)
Death

Prognosis

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.

Patient Education

For excellent patient education resources, visit eMedicine's Stroke Center. Also, see eMedicine's patient education article Stroke.

Contributor Information and Disclosures

Author

Tej K Naik, MD Associate, Southern California Permanente Medical Group, Pulmonary and Critical Care Medicine, Kaiser Foundation Hospital, Fontana, California

Tej K Naik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American Association for Respiratory Care, American College of Chest Physicians, American College of Physicians, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Cory Franklin, MD Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science; Director, Division of Critical Care Medicine, Cook County Hospital

Cory Franklin, MD is a member of the following medical societies: New York Academy of Sciences and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold L Manning, MD Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School

Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

References

Sedy J, Zicha J, Kunes J, Jendelova P, Sykova E. Mechanisms of neurogenic pulmonary edema development. Physiol Res. 2008;57(4):499-506. [Medline].
Hoff JT, Nishimura M, Garcia-Uria J, Miranda S. Experimental neurogenic pulmonary edema. Part 1: The role of systemic hypertension. J Neurosurg. May 1981;54(5):627-31. [Medline].
Maron MB, Dawson CA. Pulmonary venoconstriction caused by elevated cerebrospinal fluid pressure in the dog. J Appl Physiol. Jul 1980;49(1):73-8. [Medline].
Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. Apr 2007;51(4):447-55. [Medline].
Reuter-Rice K, Duthie S, Hamrick J. Neurogenic pulmonary edema associated with pediatric status epilepticus. Pediatr Emerg Care. Oct 2011;27(10):957-8. [Medline].
Muroi C, Keller M, Pangalu A, Fortunati M, Yonekawa Y, Keller E. Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. J Neurosurg Anesthesiol. Jul 2008;20(3):188-92. [Medline].
Piazza O, Venditto A, Tufano R. Neurogenic pulmonary edema in subarachnoid hemorrage. Panminerva Med. Sep 2011;53(3):203-10. [Medline].
Solenski NJ, Haley EC Jr, Kassell NF, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. Jun 1995;23(6):1007-17. [Medline].
Fontes RB, Aguiar PH, Zanetti MV, Andrade F, Mandel M, Teixeira MJ. Acute neurogenic pulmonary edema: case reports and literature review. J Neurosurg Anesthesiol. Apr 2003;15(2):144-50. [Medline].
Lee VH, Oh JK, Mulvagh SL, Wijdicks EF. Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2006;5(3):243-9. [Medline].
Wartenberg KE, Mayer SA. Medical complications after subarachnoid hemorrhage: new strategies for prevention and management. Curr Opin Crit Care. Apr 2006;12(2):78-84. [Medline].
Goncalves V, Silva-Carvalho L, Rocha I. Cerebellar haemorrhage as a cause of neurogenic pulmonary edema - case report. Cerebellum. 2005;4(4):246-9.
Qin SQ, Sun W, Wang HB, Zhang QL. Neurogenic pulmonary edema in head injuries: analysis of 5 cases. Chin J Traumatol. Jun 2005;8(3):172-4, 178. [Medline].
Rochester CL, Mohsenin V. Respiratory complications of stroke. Semin Respir Crit Care Med. Jun 2002;23(3):248-60. [Medline].
Brewer RP, Borel CO. Neurogenic pulmonary edema during intracranial endovascular therapy. Neurocrit Care. 2004;1(4):423-7. [Medline].
Naidech AM, Bassin SL, Garg RK, et al. Cardiac troponin I and acute lung injury after subarachnoid hemorrhage. Neurocrit Care. 2009;11(2):177-82. [Medline].
Nakamura T, Okuchi K, Matsuyama T, et al. Clinical significance of elevated natriuretic peptide levels and cardiopulmonary parameters after subarachnoid hemorrhage. Neurol Med Chir (Tokyo). May 2009;49(5):185-91; discussion 191-2. [Medline].
Fletcher SJ, Atkinson JD. Use of prone ventilation in neurogenic pulmonary oedema. Br J Anaesth. Feb 2003;90(2):238-40. [Medline].
Schraufnagel DE, Thakkar MB. Pulmonary venous sphincter constriction is attenuated by alpha-adrenergic antagonism. Am Rev Respir Dis. Aug 1993;148(2):477-82. [Medline].
Knudsen F, Jensen HP, Petersen PL. Neurogenic pulmonary edema: treatment with dobutamine. Neurosurgery. Aug 1991;29(2):269-70. [Medline].
[Guideline] Institute for Clinical Systems Improvement (ICSI). Palliative care. National Guidelines Clearinghouse. May 2008.
Jain R, Deveikis J, Thompson BG. Management of patients with stunned myocardium associated with subarachnoid hemorrhage. AJNR Am J Neuroradiol. Jan 2004;25(1):126-9. [Medline].
Ohlmacher AP. Acute pulmonary edema as a terminal event in certain forms of epilepsy. Am J Med Sci. 1910;139:417.
Simmons RL, Heisterkamp CA 3rd, Collins JA, Bredenberg CE, Mills DE, Martin AM Jr. Respiratory insufficiency in combat casualties. IV. Hypoxemia during convalescence. Ann Surg. Jul 1969;170(1):53-62. [Medline].
Simon RP, Gean-Marton AD, Sander JE. Medullary lesion inducing pulmonary edema: a magnetic resonance imaging study. Ann Neurol. Nov 1991;30(5):727-30. [Medline].
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. May 4 2000;342(18):1301-8. [Medline].
Tung P, Kopelnik A, Banki N, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. Feb 2004;35(2):548-51. [Medline].
Wray NP, Nicotra MB. Pathogenesis of neurogenic pulmonary edema. Am Rev Respir Dis. Oct 1978;118(4):783-6. [Medline].

Neurogenic pulmonary edema in a patient with a subdural hematoma.

Progression of neurogenic pulmonary edema in the same patient in the image above, with subdural hematoma (day 2).

Factors leading to the development of neurogenic pulmonary edema in patients with subarachnoid hemorrhage.

View Table List

Read more about Neurogenic Pulmonary Edema on Medscape