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Deng X, Yang CY, Zhu ZL, Tian W, Tian JX, Xia M, Pan W. Negative pressure pulmonary edema after laparoscopic cholecystectomy: A case report and literature review. Medicine (Baltimore) 2024; 103:e37443. [PMID: 38489724 PMCID: PMC10939698 DOI: 10.1097/md.0000000000037443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is an acute onset of non-cardiogenic interstitial pulmonary edema, commonly seen among surgical patients after extubation from general aneasthesia. It is mainly caused by rapid inspiration with acute upper airway obstruction resulting in significant negative thoracic pressure. PATIENT CONCERNS A 24-year-old female patient who underwent laparoscopic cholecystectomy under general anesthesia and developed NPPE postoperatively. DIAGNOSES Her main clinical manifestation was coughing up pink foamy sputum; postoperative CT showed increased texture in both lungs and bilateral ground glass opacities. INTERVENTIONS Diuretics and steroids were used, and symptomatic supportive treatments such as oxygen were given. OUTCOMES After treatment, on the fourth post-operative day, her symptoms were relieved and her vital signs were stable enough for her to be discharged. LESSONS Although this is a rare and severe complication, the prognosis of NPPE is good when it is managed with proper diagnosis and treatment.
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Affiliation(s)
- Xu Deng
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Chun-Yuan Yang
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Zong-Long Zhu
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Jian-Xing Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Ming Xia
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Pan
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
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2
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Lee DH, Lee N. Negative pressure pulmonary edema after general anesthesia using the i-gel. Saudi J Anaesth 2024; 18:123-125. [PMID: 38313720 PMCID: PMC10833014 DOI: 10.4103/sja.sja_574_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 02/06/2024] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a rare complication that occurs mainly after tracheal extubation. We report a case of postoperative NPPE associated with the use of the i-gel. A 28-year-old woman was scheduled for an emergency right axillary sentinel lymph node excision. During emergence, the patient experienced a sudden onset of airway obstruction, and spontaneous ventilation through the i-gel was impossible. Pink and frothy secretions were noted in the i-gel and the patient's oral cavity. Positive airway pressure with 100% oxygen was applied using a facemask, and the patient was subsequently treated with high-flow oxygen therapy. In this case, laryngospasm or displacement of the i-gel was believed to be the cause of airway obstruction. We recognized that NPPE is likely to occur regardless of the airway device, and the use of the i-gel cannot completely eliminate the possibility of NPPE occurrence.
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Affiliation(s)
- Deok-hee Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Nawon Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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3
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Ben-David Y, Bentur L, Gur M, Ilivitzki A, Toukan Y, Nir V, Shallufi G, Dabbah H, Bar-Yoseph R. Pediatric negative pressure pulmonary edema: Case series and review of the literature. Pediatr Pulmonol 2023; 58:3596-3599. [PMID: 37737464 DOI: 10.1002/ppul.26700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Negative pressure pulmonary edema (NPPE) is a potentially life-threatening complication that develops rapidly following acute upper airway obstruction. The condition is rare, dramatic but resolves quickly. Prompt recognition and appropriate supportive treatment may prevent unnecessary investigations and iatrogenic complications. METHODS We describe a spectrum of etiologies and clinical manifestation of pediatric NPPE in our center and review of previous publications. CONCLUSION The etiology for the development of NPPE in children has shifted over the years. Although dramatic in presentation, this type of pulmonary edema often resolves quickly with minimal support.
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Affiliation(s)
- Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Anat Ilivitzki
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Husein Dabbah
- Pediatric Pulmonary Service, Baruch Padeh Medical Center, Poriya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Zefat, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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4
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Özdemir G, Ozturk Z. An exceptional cause of acute respiratory failure in an infant: negative pressure pulmonary edema. Malawi Med J 2023; 35:234-235. [PMID: 38362569 PMCID: PMC10865057 DOI: 10.4314/mmj.v35i4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Acute respiratory failure is an important reason for pediatric intensive care admissions. Lung parenchymal disease, airway obstruction, or neuromuscular dysfunction are the most common causes. Negative pressure pulmonary edema, characterized by pulmonary edema associated with upper airway obstruction, can rarely cause sudden onset respiratory failure. Herein, we describe an infant who suffered sudden onset respiratory failure and pulmonary hemorrhage while being held facedown for a bath, was admitted to the pediatric intensive care unit, intubated and mechanically ventilated for three days, and was diagnosed with negative pressure pulmonary edema, and discharged without any sequelae. Negative pressure pulmonary edema is a rare entity. Its true frequency is not known due to the lack of awareness. This report aimed to increase clinician familiarity with negative pressure pulmonary edema in patients with sudden onset respiratory failure and/or pulmonary hemorrhage.
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Affiliation(s)
- Göktuğ Özdemir
- Department of Pediatric Intensive Care, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Zeynelabidin Ozturk
- Department of Pediatric Intensive Care, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
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5
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Ma J, Liu T, Wang Q, Xia X, Guo Z, Feng Q, Zhou Y, Yuan H. Negative pressure pulmonary edema (Review). Exp Ther Med 2023; 26:455. [PMID: 37614417 PMCID: PMC10443067 DOI: 10.3892/etm.2023.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/25/2023] [Indexed: 08/25/2023] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.
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Affiliation(s)
- Jin Ma
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Tiantian Liu
- Department of Rehabilitation, Shanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, P.R. China
| | - Qiang Wang
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Xiaohua Xia
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Zhiqiang Guo
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Qiupeng Feng
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Yan Zhou
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Hua Yuan
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
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6
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Sun J, Peng Q, Huaguo Y, Hu L, Zhou H. Severe hypoxemia after extubation secondary to myxedema coma: a case report. J Int Med Res 2023; 51:3000605231197947. [PMID: 37694899 PMCID: PMC10498701 DOI: 10.1177/03000605231197947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Myxedema coma is a rare and life-threatening endocrine emergency characterized by abnormalities in multiple organ systems. A 32-year-old woman with prolonged undiagnosed severe hypothyroidism was referred to our hospital owing to lower abdominal pain and menopause for more than 3 months. She underwent exploratory laparotomy and induced abortion under general anesthesia, and developed severe hypoxemia after extubation. She was diagnosed with myxedema coma, and was subsequently discharged with a good prognosis following treatment. This case suggests that myxedema coma should be considered a potential etiology of peri-operative hypoxemia. The findings in this case emphasize the importance of anesthesiologists' comprehensive understanding of myxedema coma. Prompt diagnosis followed by treatment is essential to reduce the mortality rate associated with this condition.
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Affiliation(s)
- Jintao Sun
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiaoyi Peng
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuefeng Huaguo
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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7
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Augustin KJ, Creel‐Bulos CM, Budhrani GF, Miller CF, Fiza B. Extracorporeal membrane oxygenation as acute rescue therapy for negative pressure pulmonary edema in the post anesthesia care unit: A case report. Clin Case Rep 2023; 11:e7606. [PMID: 37397579 PMCID: PMC10314190 DOI: 10.1002/ccr3.7606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023] Open
Abstract
Negative pressure pulmonary edema (NPPE) may result in respiratory failure refractory to conventional management strategies. Venovenous extracorporeal membrane oxygenation (VV ECMO) can serve as a rescue therapy in cases of severe respiratory failure. Rapid initiation of VV ECMO can decrease morbidity and mortality while facilitating early liberation from mechanical ventilation and promoting early rehabilitation. We describe the successful utilization of VV ECMO as rescue therapy for severe NPPE-induced hypoxic respiratory failure and peri-arrest state in the postanesthesia care unit (PACU) in a patient with postextubation airway obstruction after undergoing patellar tendon repair.
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Affiliation(s)
- Katrina J. Augustin
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Christina M. Creel‐Bulos
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Gaurav F. Budhrani
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Casey F. Miller
- Department of Surgery, Division of Cardiothoracic SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Babar Fiza
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
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8
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Hasegawa A, Niimi N, Mitaka C, Hayashida M. Negative pressure pulmonary edema due to upper airway obstruction after general anesthesia in a patient with Parkinson's disease: A case report. Clin Case Rep 2023; 11:e7444. [PMID: 37266349 PMCID: PMC10229746 DOI: 10.1002/ccr3.7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/29/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
In a patient with Parkinson's disease (PD) who underwent spine surgery 13 h after the last anti-Parkinson medications, negative pressure pulmonary edema from upper airway obstruction developed immediately after extubation. Although oxygenation improved with high-flow nasal cannula therapy, such complications might develop due to abrupt discontinuation of medication for PD.
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Affiliation(s)
- Ayaka Hasegawa
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Naoko Niimi
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Chieko Mitaka
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
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9
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Suzuki Y, Ogoshi T, Taura Y, Oda S, Uchiyama D, Ueda H, Yatera K. Atypical negative pressure pulmonary edema after extracorporeal membrane oxygenation therapy for COVID-19. Respirol Case Rep 2022; 11:e01071. [PMID: 36514343 PMCID: PMC9730701 DOI: 10.1002/rcr2.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID-19 pneumonia 4 months ago. Capillary damage from COVID-19 might still exist.
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Affiliation(s)
- Yu Suzuki
- Department of Respiratory MedicineKokura Memorial HospitalKitakyushu‐shiJapan
| | - Takaaki Ogoshi
- Department of Respiratory MedicineKokura Memorial HospitalKitakyushu‐shiJapan
| | - Yusuke Taura
- Department of Respiratory MedicineKokura Memorial HospitalKitakyushu‐shiJapan
| | - Shiori Oda
- Department of OtorhinolaryngologyKokura Memorial HospitalKitakyushu‐shiJapan
| | - Daiji Uchiyama
- Department of Diagnostic RadiologyKokura Memorial HospitalKitakyushu‐shiJapan
| | - Hiroyuki Ueda
- Department of Diagnostic RadiologyKokura Memorial HospitalKitakyushu‐shiJapan
| | - Kazuhiro Yatera
- Department of Respiratory MedicineUniversity of Occupational and Environmental HealthKitakyushu‐shiJapan
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Ikeo S, Iwata T, Yasuda N, Hayashi Y, Sokai A, Nishimura T. Negative pressure pulmonary edema in a patient with COVID-19. Respirol Case Rep 2022; 10:e01062. [PMID: 36320444 PMCID: PMC9614563 DOI: 10.1002/rcr2.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) should be considered in the differential diagnosis from an episode of asphyxia, and even if NPPE is diagnosed, the possibility of COVID‐19 should be kept in mind under coronavirus pandemic conditions.
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Affiliation(s)
- Satoshi Ikeo
- Department of Respiratory MedicineKyoto Katsura HospitalKyotoJapan
| | - Toshiyuki Iwata
- Department of Respiratory MedicineKyoto Katsura HospitalKyotoJapan
| | - Naoaki Yasuda
- Department of Respiratory MedicineKyoto Katsura HospitalKyotoJapan
| | - Yasuyuki Hayashi
- Department of Respiratory MedicineKyoto Katsura HospitalKyotoJapan
| | - Akihiko Sokai
- Department of Respiratory MedicineKyoto Katsura HospitalKyotoJapan
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Menon A, Kavaliunaite E. Infant presenting with pulmonary hemorrhage as a sequelae of accidental asphyxiation. Pediatr Pulmonol 2021; 56:3445-3446. [PMID: 34407319 DOI: 10.1002/ppul.25615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/31/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Anupama Menon
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Ema Kavaliunaite
- Department of Paediatric Respiratory Medicine, St George's Hospital NHS Foundation Trust, London, UK
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12
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Cheng JZ, Wang J. Negative Pressure Pulmonary Edema Related to Laryngospasm and Upper Airway Obstruction in a Patient With Treacher Collins Syndrome. Cureus 2021; 13:e14426. [PMID: 34079650 PMCID: PMC8159308 DOI: 10.7759/cureus.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.
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Affiliation(s)
- Jenny Zhao Cheng
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
| | - Jingping Wang
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
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Park H, Nam S, Jang YJ, Ku S, Choi SS. Negative pressure pulmonary edema in a patient undergoing open rhinoplasty: A case report. Medicine (Baltimore) 2021; 100:e24240. [PMID: 33429827 PMCID: PMC7793335 DOI: 10.1097/md.0000000000024240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is associated with serious postoperative complications. Compact nasal packing is always done after an open rhinoplasty procedure which makes it difficult to achieve positive pressure ventilation via a mask if NPPE arises. PATIENT CONCERNS A 21-year-old healthy man got an open rhinoplasty, septal perforation repair, and revisional septal reconstruction. After surgery, he became so agitated that it was difficult to calm him. We decided to remove the endotracheal tube. On arrival at the post-anesthesia care unit, he was cyanotic and his SpO2 had decreased to about 2%. We attempted positive pressure ventilation using mask bagging; however, it was ineffective due to the nasal packing. DIAGNOSES Negative pressure pulmonary edema. INTERVENTIONS Emergent reintubation was immediately done and Ambu bagging was commenced. A considerable pinkish secretion came out of the tube. A T-piece was applied to him using 15 L/min of oxygen supply. The patient was eventually transferred to the intensive care unit of our hospital. OUTCOMES On postoperative day (POD) 1, a decision was made to extubate, and the oxygen supply was shifted to 3L/min using a venturi-mask. On POD 2, a chest posteroanterior radiograph was taken and indicated no active lung lesion. The patient was subsequently discharged without any complications. He had no symptoms on POD 6, 11, and 18 at follow-up visits to our outpatient clinic. LESSONS Anesthesiologists should be alert to the possibility of NPPE and its treatment because of its rapid onset but positive clinical outcome if there is a proper intervention. In nasal surgery cases in particular, early re-intubation should be conducted and extubation should be done to fully awaken the patients.
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Affiliation(s)
| | - Sugeun Nam
- Department of Anesthesiology and Pain Medicine
| | - Yong Ju Jang
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungwoo Ku
- Department of Anesthesiology and Pain Medicine
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14
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Abstract
Negative pressure pulmonary edema (NPPE) is a noncardiogenic-related rapid onset of bilateral pulmonary edema secondary to various etiologies that lead to upper airway obstruction. Despite the fact that it is more commonly seen in the emergency department (ED), pediatric intensive care unit (PICU), and the postanesthesia care unit (PACU), there is a lower disease prevalence in the medical intensive care unit (MICU) as it sometimes could be overlooked upon. Prompt treatment often leads to favorable clinical outcomes. We detail a 55-year-old lady with a past medical history of nephrolithiasis, obesity, and obstructive sleep apnea presented with right flank pain due to right kidney subcapsular hematoma and left hydronephrosis due to distal ureteral calculus requiring urological intervention. She unfortunately subsequently developed NPPE requiring MICU level of care after reintubation. Successful extubation was achieved two days later as timely recognition of NPPE led to proper treatment. She was downgraded to general medicine service and discharged without complications.
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Affiliation(s)
- Qian Zhang
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | | | - John Ricely
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Sarah Elrod
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Ahmad Raza
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
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15
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Din-Lovinescu C, Trivedi U, Zhang K, Barinsky GL, Grube JG, Eloy JA, Hsueh WD. Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures. Ann Otol Rhinol Laryngol 2020; 130:245-253. [PMID: 32627567 DOI: 10.1177/0003489420938817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE(S) Negative pressure pulmonary edema (NPPE) is a rare perioperative complication with a potentially fatal outcome. The aim of this study was to perform a systematic review of NPPE in adult otolaryngology procedures with the goal of identifying risk factors, clinical presentation, diagnosis, management and outcomes. METHODS Systematic review performed using PubMed, Scopus, Web of Science, and Cochrane databases. RESULTS Sixty-nine studies including data from 87 individual patients were included in this review. Fifty-six (68%) patients were male and the average patient age was 37 years old. Type 1 NPPE occurred in 63 (72%) cases, while type 2 NPPE accounted for 20 (23%) cases. The most common procedures leading to NPPE were septoplasty, rhinoplasty or sinus surgery (n = 22, 25%), directly laryngoscopy or bronchoscopy (n = 13, 15%), and tracheostomy or cricothyroidotomy (n = 11, 13%). The most employed treatment options included diuretics (n = 55, 63%) and mechanical ventilation (n = 54, 62%). Seventy-eight (90%) patients made a full recovery with an average time to NPPE resolution of 33 hours and an average length of hospitalization of 5.6 days. Five (6%) patients had a long-term morbidity and four (5%) patients died, with age and ICU stay increasing risk for death and long-term morbidity (OR 1.044 and 7.42, respectively, P < .05). CONCLUSION Septoplasty, rhinoplasty and sinus surgery account for the majority of NPPE cases in adult otolaryngology procedures. Young, healthy patients are the most commonly involved with a slight male predominance. The vast majority of patients recover fully, however there is a significant risk for morbidity and mortality.
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Affiliation(s)
- Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Usha Trivedi
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
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16
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Abstract
The indications for extracorporeal membrane oxygenation (ECMO) are expanding. Postobstructive pulmonary edema, also known as negative pressure pulmonary edema, can result in severe respiratory compromise and acute respiratory distress syndrome. We present a case of a 26-year-old female with laryngeal papillomatosis and laryngospasm after direct laryngoscopy, who developed severe NPPE refractory to mechanical ventilator support, which was successfully treated with veno-venous ECMO.
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Affiliation(s)
- Brian M Grant
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Deangelo H Ferguson
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Jenna E Aziz
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Salim M Aziz
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
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17
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Fu J, Wang M, Zhang H, Luo Q. [ Negative pressure pulmonary edema secondary to laryngospasm: a case report]. Hua Xi Kou Qiang Yi Xue Za Zhi 2019; 37:450-452. [PMID: 31512843 DOI: 10.7518/hxkq.2019.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Negative pressure pulmonary edema is a rare complication of general anesthesia. This paper presents a case of acute negative pressure pulmonary edema that occurred during general anesthesia resuscitation. The patient is a young male that underwent bimaxillary surgery under general anesthesia. Laryngospasm spasm ensued after extubation. The treatment for laryngeal spasm retained the smoothness of the nasopharyngal airway, and the pulse oxygen saturation rapidly decreased after anesthesia resuscitation. Pink foam sputum was sucked out from the cavity due to respiratory shortness from mouth and nose. Highly concentrated oxygen was immediately given to assist ventilation and as a symptomatic support (diuretics, hormones), and the condition evidently improved. The diagnosis and treatment of this case suggest that when acute pulmonary edema occurs during general anesthesia resuscitation, negative pressure pulmonary edema should be highly suspected. The first line of treatment is to relieve respiratory tract obstruction. Supplying highly concentrated oxygen to assist positive pressure ventilation is an effective treatment to alleviate pulmonary edema.
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Affiliation(s)
- Jing Fu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Miao Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hong Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qiang Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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18
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Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is a dangerous clinical complication and potentially life-threatening emergency without prompt diagnosis and intervention during recovery period after anesthetic extubation. PATIENT CONCERNS A 25-year-old woman has undergone endoscopic thyroidectomy. After extubation, the patient developed acute respiratory distress with high airway resistance accompanied with wheezing, oxyhemoglobin saturation (SpO2) decreased to 70%. With positive pressure mask ventilation, her condition was stable, SpO2 99%. However, the patient developed pink frothy sputum with diffuse bilateral rales 30 min later after transported to surgical intensive care unit (SICU). DIAGNOSES Negative pressure pulmonary edema. INTERVENTIONS The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and furosemide 20 mg was given intravenously. OUTCOMES Postoperative day (POD) 2 her condition became stable, computed tomography (CT) scan indicated the pulmonary edema disappeared. The patient was discharged 6 days later. No abnormalities were observed during following 4 weeks. LESSONS Although usually the onset of NPPE is rapid, with individual differences NPPE is still challenging. Increased vigilance in monitoring, diagnosis, and treatment are essential to prevent aggravation and further complication.
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19
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Abstract
RATIONALE Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH. PATIENT CONCERNS A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia. DIAGNOSIS Chest x-ray and computed tomography showed DAH. INTERVENTIONS Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid. OUTCOMES The patient was discharged uneventfully. LESSONS Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.
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Affiliation(s)
| | | | | | | | - Bong Hee Park
- Department of Urology, Uijeongbu St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Su Bin Yoo
- Department of Anesthesiology and Pain Medicine
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20
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Rosero-Britton B, Uribe A, Stoicea N, Periel L, Bergese SD. Negative pressure pulmonary edema postextubation following medial nerve repair with sural graft surgery in a young patient: A case report. Medicine (Baltimore) 2018; 97:e13743. [PMID: 30593150 PMCID: PMC6314689 DOI: 10.1097/md.0000000000013743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is a serious well-described pulmonary complication. It occurs after an intense inspiratory effort against an obstructed or closed upper airway and generates a large negative airway pressure, leading to severe pulmonary edema (transvascular fluid filtration and interstitial/alveolar edema) and hypoxemia. We present a case of NPPE following general anesthesia in a patient who underwent median nerve neurorrhaphy with graft from lower left limb (sural nerve) due to sharp injury. PATIENT CONCERNS A 39-year-old Hispanic male was admitted to the Hospital Universitario de San José and scheduled to undergo a median nerve neurorrhaphy under general anesthesia. Preoperative vital signs, physical examination, and laboratory assessments were unremarkable. At the end of surgery, anesthetic agents were ceased after patient responded to commands and maintained eye contact. However, immediately after extubation, anesthesia care providers observed marked respiratory distress and rapid development of hypoxia. DIAGNOSES After extubation, patient presented multiple episodes of hemoptysis, tachypnea (25 per minute), blood oxygen saturation (SpO2) of 82% and abundant bilateral pulmonary rales. A baseline chest x-ray revealed symmetric parenchymal opacities with ground-glass attenuation and bilateral multilobar consolidations patterns. The diagnosis of NPPE was established and supportive treatment was initiated. INTERVENTIONS The patient received noninvasive mechanical ventilation with a PEEP at 10 cmH2O, intravenous furosemide (20 mg.) every 12 hours, and fluids restriction. Patient remained in PACU for continuing monitoring and laboratory/imaging follow-up testing until next morning. OUTCOMES On postoperative day 1, patient responded satisfactorily to supportive treatment and transferred to the general care floor; oxygen supplementation was discontinued 12 hours after extubation time. On postoperative day 3, after the evaluation of a chest x-ray, patient was discharged to home in stable conditions LESSON:: The occurrence of NPPE in the perioperative setting could be successfully managed with supportive regimens, effective clinical team coordination, and awareness of the importance of its rapid diagnosis.
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Affiliation(s)
- Byron Rosero-Britton
- Grupo de Investigaciones Básicas y Clínicas, Gibacus, Universidad del Sinú, Cartagena
- Department of Anesthesiology, Hospital Universitario de San José, Bogota, Colombia
| | - Alberto Uribe
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Nicoleta Stoicea
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Luis Periel
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Sergio D. Bergese
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH
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21
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Yamaga S, Shime N, Ishii J. Regional Negative Pressure Pulmonary Edema with Pulmonary Thromboembolism. Intern Med 2018; 57:1805-1806. [PMID: 29434139 PMCID: PMC6047985 DOI: 10.2169/internalmedicine.0295-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Satoshi Yamaga
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Junki Ishii
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
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22
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Abstract
Postoperative negative pressure pulmonary edema (NPPE) is a rare, but well-known life-threatening complication of acute upper airway obstruction (UAO) which develops after general anesthesia. The pronounced inspiratory efforts following UAO lead to excessive negative inspiratory pressure, which may cause acute pulmonary edema. Early recognition and prompt treatment of NPPE is necessary to prevent patient morbidity and mortality. In addition, the physician should carefully manage the patient who has risk factors of UAO to prevent this situation. We experienced a case of NPPE following laryngospasm after tracheal extubation in an obese patient who underwent open reduction of orbital wall and nasal bone surgery.
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Affiliation(s)
- Eunkyung Choi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Junggu Yi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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23
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Rasheed A, Palaria U, Rani D, Sharma S. A case of negative pressure pulmonary edema in an asthmatic patient after laparoscopic cholecystectomy. Anesth Essays Res 2015; 8:86-8. [PMID: 25886111 PMCID: PMC4173589 DOI: 10.4103/0259-1162.128919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Negative pressure pulmonary edema is often misdiagnosed or can go clinically unrecognized by anesthesiologists. It is characterized by a markedly low intrapleural pressure which leads to exudation of fluid and red blood cells in the interstitium. Recognition of patients with predisposing factors for upper airway obstruction is important in the diagnosis which is often confused with pulmonary aspiration of gastric contents. Signs and symptoms are subtle and edema is usually self-limited. Our patient was management conservatively with maintenance of a patent airway and administration of supplemental oxygen and had a successful outcome.
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Affiliation(s)
- Asim Rasheed
- Department of Anaesthesiology and Critical Care, Government Medical College, Haldwani, Uttarkhand, India
| | - Urmila Palaria
- Department of Anaesthesiology and Critical Care, Government Medical College, Haldwani, Uttarkhand, India
| | - Dolly Rani
- Department of Anaesthesiology and Critical Care, Government Medical College, Haldwani, Uttarkhand, India
| | - Shatrunjay Sharma
- Department of Anaesthesiology and Critical Care, Government Medical College, Haldwani, Uttarkhand, India
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24
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Kaya Z, Tuncez A, Gök U, Gül EE, Altunbaş G. Negative pressure pulmonary edema following septoplasty surgery triggering acute subendocardial myocardial infarction. Heart Views 2014; 15:46-8. [PMID: 25104982 PMCID: PMC4124665 DOI: 10.4103/1995-705x.137495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) is defined as fluid transudation into the pulmonary interstitium which occurs as a result of elevated negative intrathoracic pressure caused by the upper respiratory tract obstruction and strong inspiratory effort. NPPE is usually seen during emergence from general anesthesia in the early post-operative period especially after upper respiratory tract surgery. We present a case of a 37-year-old male patient who underwent septoplasty operation and developed NPPE which could not diagnosed and progressed to acute subendocardial myocardial infarction.
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Affiliation(s)
- Zeynettin Kaya
- Department of Cardiology, Konya Numune State Hospital, Konya, Turkey
| | - Abdullah Tuncez
- Department of Cardiology, Konya Numune State Hospital, Konya, Turkey
| | - Umut Gök
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Enes Elvin Gül
- Department of Cardiology, Malkara State Hospital, Tekirdağ, Turkey
| | - Gökhan Altunbaş
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey
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25
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Abstract
Negative pressure pulmonary edema (NPPE) is a dangerous and potentially fatal condition with a multifactorial pathogenesis. Frequently, NPPE is a manifestation of upper airway obstruction, the large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. This negative pressure leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. The early detection of the signs of this syndrome is vital to the treatment and to patient outcome. The purpose of this review is to highlight the available literature on NPPE, while probing the pathophysiological mechanisms relevant in both the development of this condition and that involved in its resolution.
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Affiliation(s)
- Balu Bhaskar
- Critical Care Research Group, John B McCarthy Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia
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26
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Abstract
An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds. Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence. Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.
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Affiliation(s)
- Vikas Pathak
- Department of General Internal Medicine, Marshfield Clinic, WI 54449, USA.
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