Neurogenic pulmonary oedema

• A rare condition associated with a variety of intracranial pathologies
• SAH
• Generalized seizures
• Head injury

• Incidence rate of NPE after SAH has been reported to range from 2% to 31%

• Mortality: 59%

• Two possibly synergistic mechanisms.

flowchart LR
    A["Sudden increased ICP or <br>hypothalamic injury"] --> B["Sympathetic discharge"]
    B --> C["Redistribution of blood to <br>pulmonary circulation"]
    C --> D["Elevation of pulmonary capillary <br>wedge pressures (PCWP) + <br>increased permeability"]
    B --> E["Surge of catecholamines"]
    E --> F["Disruption of capillary<br>endothelium"]
    F --> G
    D --> G["Increased alveolar <br>permeability"]

• Supportive
• Positive pressure ventilation with low levels of PEEP (p.906) and treatment to normalize ICP.

• A PA-catheter is usually helpful.

• There may be some efficacy in using a dobutamine infusion supplemented with furosemide as needed.
• The theoretical advantage of dobutamine over previously attempted alpha- and beta-blockers is that dobutamine does not reduce cerebral perfusion.