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Updated: Jun 28, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
A change of position for neurogenic pulmonary edema
Scott A Marshall1, Paul Nyquist
1Department of Neurosciences Critical Care, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA. smarsh15@jhmi.edu
Introduction:
Stroke is the third most common cause of death in the Western World and is a condition seen by Neurologists, General Physicians and Primary Care Physicians. Neurogenic pulmonary edema can complicate the management of large strokes and cerebral hemorrhage. While the principles of management of this type of pulmonary edema are similar to the more common cardiogenic pulmonary edema, placing a patient in the prone position may be a helpful maneuver facilitating recovery.
Methods:
We describe a case of basilar thrombosis treated with intra-arterial thrombolysis where prone ventilation was employed to treat neurogenic cardio-pulmonary complications.
Results:
This resulted in rapid resolution of neurogenic pulmonary edema and patient recovery after recanulation of the basilar artery by intra-arterial urokinase.
Conclusion:
This technique of prone positioning for ventilation is of importance to physicians who manage stroke and its complications.
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The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.