BACKGROUND: Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the bedside relevant information on the state of aeration and ventilation of the lung. METHODS: We describe a case report of acute respiratory insufficiency after posterior cranial fossa surgery. RESULTS: The patient underwent a subtotal meningiomectomy. Postoperative course was complicated by respiratory failure with unstable hemodynamic parameters. The pulmonary edema was suspected, and sonography examination was performed. Lung ultrasound showed typical signs for non-cardiogenic pulmonary edema. Transthoracic echocardiography showed preserved left ventricle systolic function, but signs of the severe hypovolemia were found. We corrected for the preload and ventilator support settings. Within 24 h, her respiratory status improved with a resolution of the pulmonary edema. CONCLUSIONS: Lung ultrasound at the bedside can provide accurate information on lung status in neurocritically ill patients with acute respiratory failure. The addition of transthoracic echocardiography to lung sonography provides an additive insight on the eventual pulmonary involvement. Lung ultrasound has the potential to become a reference tool for bedside dynamic respiratory monitoring in the Neuro ICU.
BACKGROUND:Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the bedside relevant information on the state of aeration and ventilation of the lung. METHODS: We describe a case report of acute respiratory insufficiency after posterior cranial fossa surgery. RESULTS: The patient underwent a subtotal meningiomectomy. Postoperative course was complicated by respiratory failure with unstable hemodynamic parameters. The pulmonary edema was suspected, and sonography examination was performed. Lung ultrasound showed typical signs for non-cardiogenic pulmonary edema. Transthoracic echocardiography showed preserved left ventricle systolic function, but signs of the severe hypovolemia were found. We corrected for the preload and ventilator support settings. Within 24 h, her respiratory status improved with a resolution of the pulmonary edema. CONCLUSIONS: Lung ultrasound at the bedside can provide accurate information on lung status in neurocritically illpatients with acute respiratory failure. The addition of transthoracic echocardiography to lung sonography provides an additive insight on the eventual pulmonary involvement. Lung ultrasound has the potential to become a reference tool for bedside dynamic respiratory monitoring in the Neuro ICU.
Authors: Giovanni Volpicelli; Mahmoud Elbarbary; Michael Blaivas; Daniel A Lichtenstein; Gebhard Mathis; Andrew W Kirkpatrick; Lawrence Melniker; Luna Gargani; Vicki E Noble; Gabriele Via; Anthony Dean; James W Tsung; Gino Soldati; Roberto Copetti; Belaid Bouhemad; Angelika Reissig; Eustachio Agricola; Jean-Jacques Rouby; Charlotte Arbelot; Andrew Liteplo; Ashot Sargsyan; Fernando Silva; Richard Hoppmann; Raoul Breitkreutz; Armin Seibel; Luca Neri; Enrico Storti; Tomislav Petrovic Journal: Intensive Care Med Date: 2012-03-06 Impact factor: 17.440
Authors: Belaïd Bouhemad; Hélène Brisson; Morgan Le-Guen; Charlotte Arbelot; Qin Lu; Jean-Jacques Rouby Journal: Am J Respir Crit Care Med Date: 2010-09-17 Impact factor: 21.405