Pathophysiology and Management of Neurogenic Pulmonary Edema in Patients with Acute Severe Brain Injury

Purpose: This article will provide a narrative review of evidence regarding proposed mechanisms, diagnosis, and treatment of neurogenic pulmonary edema (NPE) in the critical care setting.

Methods: PubMed and Ovid databases were searched for observational or prospective studies relevant to the diagnosis and treatment of NPE.

Results: While the specific mechanisms responsible for NPE remain uncertain, putative mechanisms include catecholamine release with resultant pulmonary vasoconstriction termed the “blast injury theory”, increased vagal tone, and increased capillary permeability. Diagnosis involves identifying signs of pulmonary edema in the setting of a brain injury, and treatment modalities appear to work best when balanced towards maintaining a normal physiologic state.

Conclusion: Acute Brain Injury (ABI) consists of any acquired insult to the brain and is a significant cause of morbidity and mortality worldwide. Approximately 20–30% of patients with ABI develop lung injury. Neurogenic Pulmonary Edema (NPE) is an often underdiagnosed, but an important sequela of ABI, which may result in additional long-term morbidity. It is therefore an important for providers to recognize and tailor their clinical approach towards.


Matthew A Maslonka, Sudhir V Datar, Kristin N Sheehan*, Vidula Vachharajani, Andrew Namen

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