Treatment
The three essential resuscitative steps for stabilizing the patient are indispensable.
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- Clearing and securing the airway is often done first. It may require putting a breathing tube inside the patient’s trachea.
- The second step is to administer oxygen through a face mask or using nasal prongs,
- and the third step is injecting medications that make the heart’s job easier, including diuretics, nitroglycerin, dopamine, dobutamine, Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors), and Angiotensin II Receptor Blockers (ARBs).
These are often referred to as the “ABCs”: Airway, Breathing, and Circulation.
The most critical step, however, is to correct the underlying neurological problem. If the neural pathology is treated, the torrent of catecholamines is stopped, and the neurogenic pulmonary edema often resolves on its own within hours. Treatment of the cause is either medical or surgical:
Medical treatment of neurogenic pulmonary edema is not very well documented in the literature but should include alpha-blockers, which prevent catecholamines from acting on the respiratory and cardiovascular systems, thus directly combating the most likely mechanism for the development of neurogenic pulmonary edema.
Patients with intracranial bleeding should be given drugs to cautiously decrease blood pressure, as well as clotting factors to stop the hemorrhage. Seizure patients should receive antiepileptic drugs, and people with bacterial meningitis need antibiotics, bed rest, and antipyretics.
Surgical care is often considered the mainstay of therapy. Examples include surgical decompression, clipping or coiling of the blood vessels that bled into the brain or removing the incriminated brain tumor.
