title: Identification and Treatment of the Early Form of Neurogenic Pulmonary Edema in Emergency Room.
abstract: To improve the management of the early neurogenic pulmonary edema(NPE)in patients with non-traumatic cerebral hemorrhage.
  
  
  
  Totally 140 eligible patients with non-traumatic cerebral hemorrhage who were treated in the emergency department of our hospital from October 2008 to October 2014 were divided into two groups:NPE group(n=25)and non-NPE group(n=115). The clinical data were analyzed and compared.
  
  
  
  Although the mean arterial pressure was similar between these two groups,the median pH and the bicarbonate ion(HCO(3)(-))were significantly lower in the NPE group than in the non-NPE group(pH:7.32 vs.7.39,P=0.002;HCO(3)(-),20.6 mmol/L vs.22.7 mmol/L,P=0.01). Multivariate regression analysis indicated that younger age and higher glucose level were significantly correlated with the early onset of NPE in the NPE group than in the non-NPE group(age:50.1 years vs.65.1 years,P=0.0008;glucose,15.4 mmol/L vs.10.78 mmol/L,P=0.001).There were only 3 patients in all with non-traumatic cerebral hemorrhage happened the fulminant NPE in 1 hour. Within 24 hours after patients visited the emergency room,the condition was improved in 20 of 25 patients in the NPE group. However,5 patients died,among whom 3 patients with fulminant NPE(onset within 1 hour)died due to acute respiratory distress syndrome and complicated with multiple organ failure,and 2 died of cerebral hernia.
  
  
  
  NPE is a rare and severe complication in patients with non traumatic cerebral hemorrhage. The possibility of NPE should be considered in relatively young patients with higher glucose and lower blood pH value. Timely prevention and treatment can improve the outcomes.
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Hong-Sheng
authors.initials: HS
authors.lastname: Liu
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Su
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhao
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Ying-Fei
authors.initials: YF
authors.lastname: Guo
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Yong-Ming
authors.initials: YM
authors.lastname: Yao
authors.affiliation: Emergency Department,the First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China.
authors.forename: Qing-Hong
authors.initials: QH
authors.lastname: Zhang
mesh_terms: D004636:Emergency Service, Hospital; D005947:Glucose; D006801:Humans; D011654:Pulmonary Edema
chemical_list: D005947:Glucose