Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review

  • Authors:
    • Xiaoping Lin
    • Zhijun Xu
    • Pengfei Wang
    • Yan Xu
    • Gensheng Zhang
  • View Affiliations

  • Published online on: August 23, 2016     https://doi.org/10.3892/etm.2016.3615
  • Pages: 2341-2347
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Abstract

Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. The current study reported the case of a 67‑year‑old man with severe TBI who was transferred to our intensive care unit (ICU). On day 7 after hospitalization, the patient suddenly suffered tachypnea, tachycardia, systemic hypertension and hypoxemia during lumbar cistern drainage. Intravenous diuretics, tranquilizer and glucocorticoid were administered due to suspected left heart failure attack. Chest radiography examination supported the diagnosis of pulmonary edema; however, hypotension and hypovolemia were subsequently observed. Pulse index continuous cardiac output (PiCCO) hemodynamic monitoring and bedside echocardiography were performed, which excluded the diagnosis of cardiac pulmonary edema, and thus the diagnosis of NPE was confirmed. Goal‑directed therapy by dynamic PiCCO monitoring was then implemented. In addition, levosimendan, an inotropic agent, was introduced to improve cardiac output. The patient had complete recovered from pulmonary edema and regained consciousness on day 11 of hospitalization. The current case demonstrated that PiCCO monitoring may serve a central role in the integrated management of NPE in patients with TBI. Levosimendan may be a potential medicine in treating cardiac dysfunction, along with its benefit from improving neurological function in NPE patients.
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October-2016
Volume 12 Issue 4

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Lin X, Xu Z, Wang P, Xu Y and Zhang G: Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review. Exp Ther Med 12: 2341-2347, 2016
APA
Lin, X., Xu, Z., Wang, P., Xu, Y., & Zhang, G. (2016). Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review. Experimental and Therapeutic Medicine, 12, 2341-2347. https://doi.org/10.3892/etm.2016.3615
MLA
Lin, X., Xu, Z., Wang, P., Xu, Y., Zhang, G."Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review". Experimental and Therapeutic Medicine 12.4 (2016): 2341-2347.
Chicago
Lin, X., Xu, Z., Wang, P., Xu, Y., Zhang, G."Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review". Experimental and Therapeutic Medicine 12, no. 4 (2016): 2341-2347. https://doi.org/10.3892/etm.2016.3615