Neurogenic pulmonary edema following seizures: A retrospective computed tomography study

Mahdavi, Yasser; Surges, Rainer; Nikoubashman, Omid; Dague, Karmele Olaciregui; Brokmann, Jörg Christian; Willmes, Klaus; Wiesmann, Martin; Schulz, Jörg B.; Matz, Oliver

doi:10.1016/j.yebeh.2019.02.006

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…This study provides new information related to rates of VAE among various neurocritical conditions. The occurrence of VAE among patients with subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, status epilepticus, and isolated brain injury may highlight reactionary changes in PEEP and FiO2 changes as acute lung injury or acute lung injury or acute respiratory distress syndrome develops commonly in these conditions [12][13][14][15][16][17][18]. In summary, VAEs are prevalent, occur mostly during the first week of illness, and are present across various neurological conditions.…”

Section: Prevalence Of Vae In Neurocritical Carementioning

confidence: 99%

Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator-Associated Events in Neurocritically Ill Patients

Fong

Walters

et al. 2020

Neurocrit Care

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Background: The prevalence, characteristics, and outcomes related to the ventilator-associated event(s) (VAE) in neurocritically ill patients are unknown and examined in this study. Methods:A retrospective study was performed on neurocritically ill patients at a 413-bed level 1 trauma and stroke center who received three or more days of mechanical ventilation to describe rates of VAE, describe characteristics of patients with VAE, and examine the association of VAE on ventilator days, mortality, length of stay, and discharge to home.Results: Over a 5-year period from 2014 through 2018, 855 neurocritically ill patients requiring mechanical ventilation were identified. A total of 147 VAEs occurred in 130 (15.2%) patients with an overall VAE rate of 13 per 1000 ventilator days and occurred across age, sex, BMI, and admission Glasgow Coma Scores. The average time from the start of ventilation to a VAE was 5 (range 3-48) days after initiation of mechanical ventilation. Using Centers for Disease Control and Prevention definitions, VAEs met criteria for a ventilator-associated condition in 58% of events (n = 85), infection-related VAE in 22% of events (n = 33), and possible ventilator-associated pneumonia in 20% of events (n = 29). A most common trigger for VAE was an increase in positive end-expiratory pressure (84%). Presence of a VAE was associated with an increase in duration of mechanical ventilation (17.4[IQR 20.5] vs. 7.9[8.9] days, p < 0.001, 95% CI 7.86-13.92), intensive care unit (ICU) length of stay (20.2[1.1] vs. 12.5[0.4] days, p < 0.001 95% CI 5.3-10.02), but not associated with in-patient mortality (34.1 vs. 31.3%. 95% CI 0.76-1.69) or discharge to home (12.7% vs. 16.3%, 95% 0.47-1.29).Conclusions: VAE are prevalent in the neurocritically ill. They result in an increased duration of mechanical ventilation and ICU length of stay, but may not be associated with in-hospital mortality or discharge to home.

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Section: Prevalence Of Vae In Neurocritical Carementioning

confidence: 99%

Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator-Associated Events in Neurocritically Ill Patients

Fong

Walters

et al. 2020

Neurocrit Care

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“…Recently, possible associations between obstructive sleep apnea and SUDEP risk were also discussed [54]. In addition to that, epileptic seizures, particularly GTCS and FBTCS with a duration of more than 100 seconds, can lead to clinically unapparent neurogenic pulmonary edema, most likely due to a massive seizure related release of catecholamines [55,56]. Accordingly, post-mortem examinations of SUDEP patients showed signs of pulmonary edema in 62% of the cases [57,58].…”

Section: Seizure-related Respiratory Dysfunction and Deficits In Serotoninergic Signalingmentioning

confidence: 99%

Prevention of sudden unexpected death in epilepsy: current status and future perspectives

Pensel

Nass

Taubøll

et al. 2020

Expert Review of Neurotherapeutics

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Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1000 people with epilepsy, and even more in medically refractory epilepsy. As most people are between 20 and 40 years when dying suddenly, SUDEP leads to a considerable loss of potential life years. The most important risk factors are nocturnal and tonic-clonic seizures, underscoring that supervision and effective seizure control are key elements for SUDEP prevention. The question of whether specific antiepileptic drugs are linked to SUDEP is still controversially discussed. Knowledge and education about SUDEP among healthcare professionals, patients and relatives are of outstanding importance for preventive measures to be taken, but still poor and widely neglected.

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“…In one retrospective study that involves reviewing chest CT scan for patients presenting with seizures as part of their emergency diagnostics, it was found that NPE was more frequent in cases of generalized convulsive seizures [12]. Recurrent NPE was also reported as the cause of two consecutive intensive care unit admissions following generalized convulsive seizures [13].…”

Section: Discussionmentioning

confidence: 99%

Neurogenic Pulmonary Edema Following a Seizure: A Case Report and Literature Review

Najim

Hammamy

Sasi

2019

Case Reports in Neurological Medicine

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Acute pulmonary edema is one of the frequent causes of dyspnea encountered in everyday practice. It is broadly attributed to be either cardiogenic or noncardiogenic. It is usually treated with diuretics in addition to other medications depending on the underlying pathology. Here, we report a case of a female patient who presented with shortness of breath after developing a seizure. Further investigations excluded cardiogenic etiology and showed critically low phenytoin level. It improved within 48 h of supportive care without giving diuretics favoring the diagnosis of neurogenic pulmonary edema as the primary pathology. The goal of our case report is to keep neurogenic pulmonary edema in mind, and hence provide the appropriate management, when dealing with similar cases.

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Neurogenic pulmonary edema following seizures: A retrospective computed tomography study

Cited by 11 publications

References 12 publications

Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator-Associated Events in Neurocritically Ill Patients

Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator-Associated Events in Neurocritically Ill Patients

Prevention of sudden unexpected death in epilepsy: current status and future perspectives

Neurogenic Pulmonary Edema Following a Seizure: A Case Report and Literature Review

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