Fb. Rogers et al., NEUROGENIC PULMONARY-EDEMA IN FATAL AND NONFATAL HEAD-INJURIES, The journal of trauma, injury, infection, and critical care, 39(5), 1995, pp. 860-868
Impaired pulmonary function is a frequent but poorly understood compli
cation of acute head injury (HI), A potential early contributor to the
pulmonary dysfunction seen in HI patients is neurogenic pulmonary ede
ma (NPE). We hypothesized that NPE would occur early after HI and that
it would have a continuum of clinical severity depending on the sever
ity of the HI and associated intracranial hypertension, A large autops
y data base and inpatient HI data base were used to search for cases o
f NPE, Patients in the autopsy data base were stratified according to
injury type and whether they died at the scene or within 96 hours of i
njury, There were significant (p < 0.0001, analysis of variance) eleva
tions in lung weights in patients dying at the scene and within 96 hou
rs from HI, compared with those dying from other noncentral nervous sy
stem injuries, No other organs studied showed significant weight incre
ases. The incidence of NPE in isolated HI patients dying at the scene
was 32%, In patients with isolated HI dying within 96 hours, the incid
ence of NPE was 50%. We found an inverse correlation (r = 0.62; p < 0.
0014) between the initial cerebral perfusion pressure and the PaO2/FIO
2 ratio despite a normal-appearing chest x-ray film, We conclude that
NPE occurs frequently in HI patients. The process of edema formation b
egins early in the clinical course and is isolated to the lung. Furthe
rmore, surviving HI patients manifest a significantly decreased PaO2/F
IO2 ratio in the presence of a normal chest x-ray film, which seems to
be related to a decrease in cerebral perfusion pressure and may be ca
used, in part, by NPE.