title: Bedside lung ultrasound: a case of neurogenic pulmonary edema.
abstract: BACKGROUND
  Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the bedside relevant information on the state of aeration and ventilation of the lung.
  
  
  METHODS
  We describe a case report of acute respiratory insufficiency after posterior cranial fossa surgery.
  
  
  RESULTS
  The patient underwent a subtotal meningiomectomy. Postoperative course was complicated by respiratory failure with unstable hemodynamic parameters. The pulmonary edema was suspected, and sonography examination was performed. Lung ultrasound showed typical signs for non-cardiogenic pulmonary edema. Transthoracic echocardiography showed preserved left ventricle systolic function, but signs of the severe hypovolemia were found. We corrected for the preload and ventilator support settings. Within 24 h, her respiratory status improved with a resolution of the pulmonary edema.
  
  
  CONCLUSIONS
  Lung ultrasound at the bedside can provide accurate information on lung status in neurocritically ill patients with acute respiratory failure. The addition of transthoracic echocardiography to lung sonography provides an additive insight on the eventual pulmonary involvement. Lung ultrasound has the potential to become a reference tool for bedside dynamic respiratory monitoring in the Neuro ICU.
authors.affiliation: Department of Neuro ICU, Republican Hospital, Pirogov Str.3, Petrozavodsk, Karelia 185000, Russia. vmerov@mail.ru
authors.forename: Vladimir V
authors.initials: VV
authors.lastname: Merenkov
authors.forename: Alexey N
authors.initials: AN
authors.lastname: Kovalev
authors.forename: Vyacheslav V
authors.initials: VV
authors.lastname: Gorbunov
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000209:etiology; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography