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I read and enjoyed the article titled "Neurogenic Pulmonary Edema Due to Traumatic Brain Injury: Evidence of Cardiac Dysfunction" (September 2006: 462-470). This article was especially timely because our trauma service recently treated a 12 year old who had an isolated head injury and developed neurogenic pulmonary edema. Unfortunately, the head injury was severe and the patient did not survive. The patient’s age and family dynamics made this loss particularly difficult to cope with.

The discovery that patients with neurogenic pulmonary edema have myocardial dysfunction is not surprising. Reinforcing similar studies, this article suggests that an increase in intracranial pressure can result in massive autonomic discharge. The direct effects of systemic catecholamines alone, as well as transient systemic hypertension, can affect left ventricular performance. Understanding all of the potential mechanisms for cardiac dysfunction may lead to the discovery of early interventions that will prevent untoward deaths.

There are many educational challenges in caring for brain-injured patients and their families. Thank you for your consideration of this poorly understood complication in central nervous system injuries.

Sandra Smith, RN
West Palm Beach, Fla

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Smith, S. Search for Related Content PubMed PubMed Citation Articles by Smith, S.