Treatment is supportive and primarily includes administration of supplemental oxygen. Additional therapy depends on the underlying cause (eg, antiepileptic drugs to control seizures, antibiotics and pain medication for oral ulceration from electrocution). Sedating analgesics (eg, morphine) may also be considered if the patient’s anxiety and stress is exacerbating respiratory distress.
In patients with NCPE, the massive catecholamine release can damage the pulmonary endothelium, increase pulmonary microvascular permeability, and cause protein and fluid to leak into interstitial and alveolar spaces. As a result, IV fluids must be used judiciously to prevent worsening of the pulmonary edema. Although furosemide use has been reported, there is not currently sufficient evidence to support standard use in NCPE patients. While furosemide can be considered to decrease bronchospasms and act as a bronchodilator, it has several risks, notably dehydration, as these patients frequently cannot tolerate high fluid rates (because of microvascular permeability and risk for worsening pulmonary edema). Furosemide would not be successful in removing this type of edema and may even remove hydrostatic fluid, leaving protein-rich material in the airways.
While underlying diseases may warrant specific therapy (eg, antibiotics for oral ulceration), evidence supporting the use of corticosteroids, bronchodilators, or antibiotics in patients with NCPE is lacking.