We read with interest the article by Davison et al1 in CHEST (March 2012). The authors reported rapid resolution of refractory ARDSeurogenic pulmonary edema after IV phentolamine was administered as a last resort. We believe that, although merely a singlet, when seen within the larger context of the literature on the pulmonary effects of catechol excess, the authors' description points to a novel treatment modality for this poorly understood disease.The association of pulmonary edema with catecholamine excess was recognized more than a century ago by investigators who found that high-dose epinephrine reliably induced cardiopul-monary failure in various animal models of shock.23 Berk et al4 showed detrimental effects on pulmonary gas exchange after infusion of epinephrine in anesthetized dogs. We reported the acute deterioration of arterial oxygen tension and pulmonary gas exchange in rats within a minute of bolus epinephrine administration.
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