Neurogenic pulmonary edema in patients with subarachnoid hemorrhage

Neurogenic pulmonary edema (NPE), leading to cardiopulmonary dysfunction, is a potentially life-threatening complication in patients with aneurysmal subarachnoid hemorrhage (SAH). We sought to assess the clinical presentation and risk factors for the development of NPE after SAH. The database contained prospectively collected information on 477 patients with SAH. Baseline characteristics, clinical and radiologic severity of the bleeding, localization of the ruptured aneurysm, and clinical outcome of patients with NPE were compared with those of patients without NPE. Further, in patients with NPE, intracranial pressure, serum cardiac biomarkers, and hemodynamic parameters during the acute phase were evaluated retrospectively. The incidence of NPE was 8% (39 of 477 patients). Most patients with NPE were severely impaired and all of them presented with radiologically severe hemorrhage. The incidence of NPE was significantly higher in patients with ruptured aneurysm in the posterior circulation. Elevated intracranial pressure was found in 67%, pathologically high cardiac biomarkers in up to 83% of patients with NPE. However, no patient suffered from persistent cardiac dysfunction. Compared with patients without NPE, patients with NPE showed poor neurologic outcome (Glasgow outcome scale 1 to 3 in 25% vs.77% of patients). In conclusion, patients with NPE have a high mortality rate more likely due to their severity grade of the bleeding. Morbidity and mortality due to cardiopulmonary failure might be reduced by appropriate recognition and treatment. The awareness of and knowledge about occurrence, clinical presentation, and treatment of NPE, are essential for all those potentially confronted with patients with SAH in the acute phase.

Management of Increased Intracranial Pressure

Brain edema and the resulting increase in intracranial pressure may be the result of several conditions: head trauma, intracranial hemorrhage, embolic stroke, infections, tumors, and alterations in cerebral spinal fluid production or absorption. At times, these patients may be treated outside of the neurological intensive care unit (ICU) for a variety of reasons. Therefore, general critical care nurses may find themselves in the position of caring for these patients. Maintaining expertise outside of one's area of focus is increasingly difficult to do, and the non-neuro critical care nurse may be unfamiliar with some of the newer research findings and trends in treating these patients. The purpose of this article is to review several of the concepts of neurological care and to update critical care nurses in various newer approaches to caring for patients with increased intracranial pressure.