Neurogenic pulmonary edema induced by subarachnoid hemorrhage:; case report on diagnostic and therapeutic implications

• Authors: Guenter Weiss , Frank Meyer
• Languages of publication: EN

Abstracts

EN

An exemplary rare case of neurogenic pulmonary edema induced by intracranial hemorrhage was reported including diagnostic and therapeutic implications as well as management recommendations. A 35-year old man who was treated first by a neurosurgical approach because of a subarachnoid hemorrhage (bore hole trepanation) and subsequently on a surgical intensive care unit because of severe postoperative hemodynamic, cardiocirculatory, and pulmonary disruptions. To monitor cardiopulmonary condition and treatment effects, a Swan-Ganz catheter was placed in the pulmonary artery, since after trepanation, a critical cardiopulmonary status developed during postoperative mechanical ventilation and catecholamine administration. This condition was indicated by neurogenic pulmonary edema detected by control chest X-ray film and high oxygen load in the inspiratory air required for sufficient arterial oxygenation. After use of high positive end-exspiratory pressure (PEEP) (initially directed against neurogenic lesion), adaptation of initial dobutamine doses, initiation of norepinephrine administration, and substitution of fluids, the patient's blood pressure finally rose sufficiently to sustain regular cerebral blood perfusion and achieve better arterial oxygenation. Thus, the patient‘s cardiopulmonary condition stabilized and temporary cardiac insufficiency could be overcome. Subsequently, it became possible to decrease PEEP according to requirements to prevent or limit cerebral edema and to diminish catecholamine doses.

Keywords

EN

neurogenic pulmonary edema   subarachnoidal hemorrhage   catecholamine  

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 87
• Issue: 4
• Pages: 189-193

Dates

published

1 - 4 - 2015

online

3 - 7 - 2015

received

31 - 1 - 2015

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Identifiers

DOI

10.1515/pjs-2015-0043