Lin Xiaoping, Xu Zhijun, Wang Pengfei, Xu Yan, Zhang Gensheng
Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
General Intensive Care Unit, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
Exp Ther Med. 2016 Oct;12(4):2341-2347. doi: 10.3892/etm.2016.3615. Epub 2016 Aug 23.
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.
神经源性肺水肿（NPE）偶尔会在创伤性脑损伤（TBI）患者中观察到；然而，这种情况常常未得到充分认识。由于其非典型的临床表现，NPE经常被误诊，从而延误了适当的治疗。TBI患者NPE的综合管理方案尚未建立。本研究报告了一例67岁重度TBI男性患者，该患者被转入我们的重症监护病房（ICU）。住院第7天，患者在腰大池引流期间突然出现呼吸急促、心动过速、全身性高血压和低氧血症。因怀疑左心衰竭发作，给予了静脉利尿剂、镇静剂和糖皮质激素。胸部X线检查支持肺水肿的诊断；然而，随后观察到低血压和血容量不足。进行了脉搏指示连续心输出量（PiCCO）血流动力学监测和床边超声心动图检查，排除了心源性肺水肿的诊断，从而确诊为NPE。然后实施了通过动态PiCCO监测进行的目标导向治疗。此外，引入了强心剂左西孟旦以改善心输出量。患者在住院第11天从肺水肿中完全康复并恢复了意识。当前病例表明，PiCCO监测可能在TBI患者NPE的综合管理中发挥核心作用。左西孟旦可能是治疗心脏功能障碍的一种潜在药物，同时它对改善NPE患者的神经功能也有益处。
