A. Papa1,2, D. Lapoint2, M. B. Roberts2, A. Carrillo2, J. Collins1, S. Galiczynski1, A. Ratnasekera1 1Crozer-Keystone Medical Center,Upland, PA, USA 2Philadelphia College of Osteopathic Medicine,Philadelphia, PA, USA
Introduction:
Neurogenic Pulmonary Edema (NPE) is a rare syndrome characterized by acute pulmonary edema following a central nervous system (CNS) injury with the absence of a primary cardiogenic or pulmonary insult. There are multiple causes, including traumatic brain injury (TBI), seizures, and cerebral hemorrhage, however, the frequency, risk factors, morbidity and mortality of the disease remains widely unknown. First, we present a case report of NPE in a 22-year-old African-American male with a single gunshot wound to the head. Second, we perform a systematic review of NPE related to TBI in order to examine risk factors associated with mortality.
Methods:
PRISMA guidelines were used to conduct the study (figure 1). 1,399 articles specific to NPE were identified by searching Pubmed and Scopus. 128 records remained after applying exclusion criteria and 29 studies were included in quantitative analysis, identifying 45 patients total. Acquired patient data included admission vital signs, demographics, and mortality. Frequency data, t tests, and odds ratios were generated using IBM SPSS Version 26 to examine risk factors for mortality. Non-numerical data, such as common radiographic imaging findings, physical exam findings, pharmacologic treatments used, and ventilation strategies were also reviewed for discussion.
Results:
Overall mortality from NPE in traumatic brain injury was found to be 44.20%. Of the patients who survived, 63.6% (n=14) made a full recovery from NPE and 78.3% were discharged home. Median hospital stay was 11 days. Admission vitals, such as systolic blood pressure (mean [SD], 113.13 [20.17]) (P = .088) and heart rate (97.93 [19.89]) (P = .057) were not significant in predicting mortality. While the majority of patients were male (83.7%, n = 36), there was no associated significant risk in mortality based on sex; male (OR, 1.050; 95% CI, 0.248 – 7.913) female (OR, 0.750; 95% CI, 0.171 – 3.291). Median age was 19 years, however, age was not a significant risk factor for mortality (22.92 [12.61]) (P = .385).
Conclusion:
NPE is a syndrome defined by acute interstitial and alveolar edema following a CNS injury without a primary cardiogenic or pulmonary insult. NPE caused by TBI is rare and carries a significant mortality and morbidity. To our knowledge this is the first systematic review of NPE associated with TBI. While the generated data may provide an idea of a typical presentation of NPE, there is insufficient evidence to establish risk factors associated with mortality.
