The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Review Case Reports
Respiratory failure in the neurological patient: the diagnosis of neurogenic pulmonary edema.
Neurogenic pulmonary edema (NPE) is a potential complication of a central nervous system (CNS) insult such as intracranial hemorrhage, uncontrolled generalized seizures, head trauma, tumors, and neurosurgical procedures. The proposed etiology is massive sympathetic discharge following a CNS event. The pathogenesis is not completely understood. ⋯ There is evidence for both theories, and NPE is probably the result of a combination of the two. The treatment is mainly supportive with the use of mechanical ventilation and alpha-adrenergic blocking agents while managing increased intracranial pressure. A thorough understanding of the pathophysiological mechanisms behind the development of NPE aids in the management of these patients to prevent further complications.
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The purpose of this study was to determine the difference in rates of pulmonary complications (e.g., aspiration, pneumonia) in head-injured patients with and without concomitant alcohol intoxication. The records of 98 consecutive patients admitted over a 1-year period to a Level I Trauma Center were reviewed. The patients were grouped into three subsets: acutely intoxicated (n = 26), acutely intoxicated with a diagnosis of chronic alcoholism (n = 14), and non-intoxicated (n = 58). ⋯ We found that our strict exclusion criteria (no concomitant chest, abdominal, or pelvic trauma) limited the sample to only those patients without significant intracranial bleeding, whereas most complications in blood alcohol neuroscience research have been associated with much larger mass lesions (e.g., epidural or subdural hematomas). In addition, we found the characterizations of patients as chronically alcoholic were cumbersome and inaccurate in many cases. Future research should allow for a greater range of concomitant injuries that might suggest a positive or negative relationship to acute intoxication.