• Edward Lo-Cao, Samuel Hall, Ruth Parsell, Gordon Dandie, and Andreas Fahlström.
• Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead 2145, New South Wales, Australia; The University of Sydney, Camperdown 2006, New South Wales, Australia. Electronic address: eloc9697@uni.sydney.edu.au.
• Am J Emerg Med. 2021 Jul 1; 45: 678.e3-678.e5.

AimWe report a case of neurogenic pulmonary edema in a patient who sustained a severe traumatic brain injury in a motorbike accident and review the current literature with regards to the management of neurogenic pulmonary edema (NPE).MethodsA 17 year old male was involved in a motorbike collision into a tree. Copious amounts of pink frothy sputum was noted on scene. Rapid sequence intubation was performed on scene and video laryngoscopy demonstrated profuse frothy secretions welling up from the larynx.ResultsThe patient underwent emergency external ventricular drain insertion for intracranial pressure (ICP) monitoring. Intracranial pressures remained refractorily high and a decompressive bifrontal craniectomy was performed on the subsequent day. He was tracheostomised on admission day 24 and discharged from ICU on day 34.DiscussionNeurogenic pulmonary edema is defined as acute respiratory distress triggered by severe sympathetic discharge from acute compromise in the central nervous system. Rapid intervention with intubation is often necessary to protect the airways and facilitate diagnostic evaluation. Reduction of ICP and supportive mechanical ventilation to improve oxygenation is necessary. Positive end-expiratory pressure should be carefully applied to balance recruitment of alveoli and minimisation of ICP. Although NPE is estimated to resolve within 72 h in more than half of patients, prognosis is generally poor due to the severity of the underlying brain injury, with estimated mortality rates of between 60 and 100%.ConclusionNeurogenic pulmonary edema is a potentially life-threatening complication of severe brain injury and should be recognised early to facilitate management.Copyright © 2020 Elsevier Inc. All rights reserved.

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