NPE in SAH

 Q: What are the few predictors to expect neurogenic pulmonary edema (NPE) in patients admitted with subarachnoid hemorrhage (SAH)?

Answer: NPE can be a fatal complication after intracranial hemorrhage (ICH) particularly SAH. Intensivists should be expecting it if one or more of the following signs present in these patients: 

• hyperglycemia
• acidosis
• high lactate level
• EKG change
• heart rate variability
• elevated troponin, and 
• leukocytosis

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#neurosurgery

#surgical-critical-care

#pulmonary

References:

1. Hong-Sheng L, Qin SU, Xiao-Dong Z, et al. Identification and Treatment of the Early Form of Neurogenic Pulmonary Edema in Emergency Room. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2015; 37:343. 

2. Satoh E, Tagami T, Watanabe A, et al. Association between serum lactate levels and early neurogenic pulmonary edema after nontraumatic subarachnoid hemorrhage. J Nippon Med Sch 2014; 81:305. 

3. Chen WL, Huang CH, Chen JH, et al. ECG abnormalities predict neurogenic pulmonary edema in patients with subarachnoid hemorrhage. Am J Emerg Med 2016; 34:79. 

4. Chen WL, Chang SH, Chen JH, et al. Heart Rate Variability Predicts Neurogenic Pulmonary Edema in Patients with Subarachnoid Hemorrhage. Neurocrit Care 2016; 25:71. 

5. Nastasovic T, Milakovic B, Marinkovic JE, et al. Could cardiac biomarkers predict neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage? Acta Neurochir (Wien) 2017; 159:705.