Awareness of neurogenic pulmonary edema may lead to early intervention in brain-injured patients

American Journal of Critical Care, Nov, 2006 by Sandra Smith

I read and enjoyed the article titled "Neurogenic Pulmonary Edema Due to Traumatic Brain Injury: Evidence of Cardiac Dysfunction" (September 2006: 462-470). This article was especially timely because our trauma service recently treated a 12 year old who had an isolated head injury and developed neurogenic pulmonary edema. Unfortunately, the head injury was severe and the patient did not survive. The patient's age and family dynamics made this loss particularly difficult to cope with.

The discovery that patients with neurogenic pulmonary edema have myocardial dysfunction is not surprising. Reinforcing similar studies, this article suggests that an increase in intracranial pressure can result in massive autonomic discharge. The direct effects of systemic catecholamines alone, as well as transient systemic hypertension, can affect left ventricular performance. Understanding all of the potential mechanisms for cardiac dysfunction may lead to the discovery of early interventions that will prevent untoward deaths.

There are many educational challenges in caring for brain-injured patients and their families. Thank you for your consideration of this poorly understood complication in central nervous system injuries.

Sandra Smith, RN

West Palm Beach, Fla