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Chaverra Kornerup S, Parotto M. Extubation-Related Complications. Int Anesthesiol Clin 2024; 62:82-90. [PMID: 39233574 DOI: 10.1097/aia.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Extubation represents an essential component of airway management. While being a common procedure in anesthesiology and critical care medicine, it is accompanied by a significant risk of morbidity and mortality. Safe extubation requires considerable skills, risk stratification and advanced planning. It is important to emphasize that intentional extubation is always an elective procedure, and as such should only be executed when conditions are optimal. The purpose of this review is to discuss the complications associated with planned extubation in the adult patient, including risk factors and management strategies, mainly focusing on the postoperative setting.
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Affiliation(s)
- Santiago Chaverra Kornerup
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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2
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Kunieda K, Suzuki S, Naganuma S, Okamoto K, Ohno T, Shigematsu T, Yagi N, Oku Y, Fujishima I. Efficacy and Safety of "Vacuum Swallowing" Based on a Strong Negative Esophageal Pressure in Healthy Individuals. Dysphagia 2024:10.1007/s00455-024-10741-y. [PMID: 39153047 DOI: 10.1007/s00455-024-10741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/27/2024] [Indexed: 08/19/2024]
Abstract
Vacuum swallowing is a unique method for improving the pharyngeal passage of a bolus by creating subatmospheric negative pressure in the esophagus. However, whether healthy individuals and other patients with dysphagia can reproduce vacuum swallowing remains unclear. Therefore, this study aimed to assess whether healthy individuals verified using high-resolution manometry (HRM) could reproduce vacuum swallowing and evaluate its safety using a swallowing and breathing monitoring system (SBMS). Two healthy individuals who mastered vacuum swallowing taught this method to 12 healthy individuals, who performed normal and vacuum swallowing with 5 mL of water five times each. The minimum esophageal pressure and the maximum pressure of the lower esophageal sphincter (LES) were evaluated during each swallow using the HRM. Additionally, respiratory-swallowing coordination was evaluated using the SBMS. Ten individuals reproduced vacuum swallowing, and a total of 50 vacuum swallows were analyzed. The minimum esophageal pressure (-15.0 ± 4.9 vs. -46.6 ± 16.7 mmHg; P < 0.001) was significantly lower, and the maximum pressure of the LES (25.4 ± 37.7 vs. 159.5 ± 83.6 mmHg; P < 0.001) was significantly higher during vacuum swallowing. The frequencies of the I-SW and SW-I patterns in vacuum swallowing were 38.9% and 0%, respectively, using the SBMS. Vacuum swallowing could be reproduced safely in healthy participants with instruction. Therefore, instructing exhalation before and after vacuum swallowing is recommended to prevent aspiration.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan.
| | - Saori Suzuki
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoe Naganuma
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Naomi Yagi
- Advanced Medical Engineering Research Institute, University of Hyogo, Himeji, Hyogo, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
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3
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Furukawa K, Asai Y, Nagahisa Y, Takano K, Chiba H. Negative-Pressure Pulmonary Edema Induced by Flexible Bronchoscopy: A Case Report. Cureus 2024; 16:e64352. [PMID: 39130816 PMCID: PMC11316620 DOI: 10.7759/cureus.64352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Negative-pressure pulmonary edema (NPPE) arises from excessive inspiratory effort due to upper airway obstruction, often associated with postoperative laryngospasm and upper airway infections like epiglottitis. We present a case of NPPE during bronchoscopy. A 45-year-old female patient, who was undergoing bronchoscopy for interstitial pneumonia evaluation, was examined using a tracheal tube with a 7.5 mm internal diameter and a bronchoscope with a 5.9 mm external diameter. The patient's respiratory condition gradually worsened after intubation. We continued with the examination, supplying approximately 5 L/min of oxygen through the intubation tube. We performed an alveolar lavage, and the recovered fluid gradually turned pale and bloody. After the examination, the patient continued to expectorate pink and frothy sputum and prolonged respiratory failure. Chest radiography revealed new extensive bilateral infiltrates. We ruled out cardiogenic causes through clinical examination, electrocardiogram (ECG), and transthoracic echocardiography. As a result, we suspected that temporary upper airway obstruction during bronchoscopy led to NPPE. Applying continuous positive airway pressure (CPAP) quickly improved the pulmonary edema. The risk of NPPE during bronchoscopy needs to be acknowledged, especially when using larger bronchoscopes and smaller tracheal tubes.
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Affiliation(s)
- Kento Furukawa
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, JPN
| | - Yuichiro Asai
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, JPN
| | - Yuta Nagahisa
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, JPN
| | - Keiichiro Takano
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, JPN
| | - Hirofumi Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, JPN
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Pereira D, Pereira S, Neves C, Segura E, Assunção JP. Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case. J Perioper Pract 2024; 34:195-198. [PMID: 37886901 DOI: 10.1177/17504589231193553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. CASE REPORT A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. DISCUSSION With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.
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Affiliation(s)
- Dulce Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Clarinda Neves
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elena Segura
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - José Pedro Assunção
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
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Idota N, Takazakura R, Ikegaya H. Postmortem computed tomography imaging of negative pressure pulmonary edema induced by rice cakes: A case report. J Forensic Leg Med 2024; 101:102620. [PMID: 37988900 DOI: 10.1016/j.jflm.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
Airway obstruction by foreign bodies or laryngospasms often results in negative pressure pulmonary edema (NPPE). NPPE can develop despite the removal of airway obstruction. This is well-known among clinicians, particularly anesthesiologists, emergency physicians, pediatricians, and radiologists. Computed tomography (CT) features of NPPE include diffuse central ground-glass opacities and thickening of the bronchovascular bundles and bronchial walls. NPPE can also occur after strangulation or smothering with a plastic bag, and is sometimes fatal. Nevertheless, no reports of NPPE are available in forensic journals, and forensic practitioners may not be dedicating the necessary attention to this condition. Recently, the use of postmortem CT as an auxiliary imaging modality for autopsies has increased among forensic institutions in Japan. Understanding the mechanisms and CT findings of NPPE will be useful for forensic practitioners. Herein, we present a case wherein the postmortem CT image revealed NPPE resulting from the obstruction of the airway induced by rice cakes.
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Affiliation(s)
- Nozomi Idota
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ryutaro Takazakura
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Tonn H. Fragen zum postobstruktiven Lungenödem. Pneumologie 2023; 77:830-831. [PMID: 37884004 DOI: 10.1055/a-2154-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Hermann Tonn
- KRH Siloah, Pneumologie, Intensiv- und Schlafmedizin, Hannover
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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] [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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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] [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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Alexander A, Hughes K, Constantino-Casas F, Owen LJ. Surgical management of a laryngeal rhabdomyosarcoma in a cat. JFMS Open Rep 2023; 9:20551169231194318. [PMID: 37810575 PMCID: PMC10559712 DOI: 10.1177/20551169231194318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Case summary An 11-year-old male castrated British Shorthair was referred for investigations into an upper respiratory tract mass. A partial laryngectomy was performed to excise the mass. Marginal resection of the mass involved excision of parts of the thyroid cartilage and left arytenoid cartilage. A tracheostomy tube was maintained for 48 h postoperatively. The cat recovered without complication and was discharged at 72 h postoperatively. Histopathology of the mass was deemed most consistent with a rhabdomyosarcoma (RMS). Relevance and novel information Telephone follow-up 12 months postoperatively confirmed resolution of the clinical signs. To our knowledge, this is the first report of a laryngeal RMS in a cat. RMS should be considered a differential diagnosis for a laryngeal mass in a cat. This case demonstrates that resection via a partial laryngectomy may be a viable therapeutic option.
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Affiliation(s)
- Akash Alexander
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Katherine Hughes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Laura Jane Owen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Research Progress on the Mechanism of Right Heart-Related Pulmonary Edema. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8947780. [PMID: 35966729 PMCID: PMC9365571 DOI: 10.1155/2022/8947780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
Objective. To investigate the mechanisms underlying the development of right heart-associated PE. Background. Right heart-related pulmonary edema (PE) refers to PE resulting from impaired right heart function caused by primary or secondary factors, which is common in critically ill patients. Although the clinical manifestations of different types of right heart-related PE are similar, the pathophysiological changes and treatment methods are significantly different. According to the hemodynamic mechanism, right heart-related PE is primarily classified into two types. One is the increase of right heart flow, including extravascular compression, intravascular compression, cardiac compression, and cardiac decompression. The other type is the abnormal distribution of pulmonary circulation, including obstruction, resistance, pleural decompression, or negative pressure. With the development of hemodynamic monitoring, hemodynamic data not only help us understand the specific pathogenesis of right heart-related PE but also assist us in determining the direction of therapy and enabling individualized treatment. Summary. This article presents a review on right heart-associated PE, with a perspective of hemodynamic analysis, and emphasizes the importance of right heart function in the management of circulation. Understanding the mechanism of right heart-associated PE will not only aid in better monitoring right heart function but also help intensivists make a more accurate identification of various types of PE in the clinic.
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Affiliation(s)
- C. Egbuta
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - F. Evans
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Kim HJ, Park SK. Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National College of Medicine, Jeju, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National College of Medicine, Jeju, Korea
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Arabi Y, Al Dorzi H, Ghanem A, Hegazy M, AlMatrood A, Alchin J, Mutairi M, Aqeil A. Humidification during mechanical ventilation to prevent endotracheal tube occlusion in critically ill patients: A case control study. Ann Thorac Med 2022; 17:37-43. [PMID: 35198047 PMCID: PMC8809127 DOI: 10.4103/atm.atm_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND: Endotracheal tube (ETT) occlusion is a potentially life-threatening event. This study describes a quality improvement project to prevent ETT occlusion in critically ill patients. METHODS: After a cluster of clinically significant ETT occlusion incidents at a tertiary-care intensive care unit (ICU), the root cause analysis suggested that the universal use of heat moisture exchangers (HMEs) was a major cause. Then, we prospectively audited new ETT occlusion incidents after changing our practices to evidence-based active and passive humidification during mechanical ventilation (MV). We also compared the outcomes of affected patients with matched controls. RESULTS: During 100 weeks, 18 incidents of clinically significant ETT occlusion occurred on a median of 7 days after intubation (interquartile range, 4.8–9.5): 8 in the 10 weeks before and 10 in the 90 weeks after changing humidification practices (8.1 vs. 1.0 incidents per 1000 ventilator days, respectively). The incidents were not suspected in 94.4%, the peak airway pressure was >30 cm H2O in only 25%, and 55.6% were being treated for pneumonia when ETT occlusion occurred. Compared with 51 matched controls, ETT occlusion cases had significantly longer MV duration (median of 13.5 vs. 4.0 days; P = 0.002) and ICU stay (median of 26.5 vs. 11.0 days; P = 0.006) and more tracheostomy (55.6% vs. 9.8%; P < 0.001). The hospital mortality was similar in cases and controls. CONCLUSIONS: The rate of ETT occlusion decreased after changing humidification practices from universal HME use to evidence-based active and passive humidification. ETT occlusion was associated with more tracheostomy and a longer duration of MV and ICU stay.
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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] [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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15
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Uslu A, Karaveli A. Negative pressure pulmonary edema: A rare complication of septorhinoplasty and a report of two cases. TURKISH JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.4103/tjps.tjps_17_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Mesrati MA, Jaoued O, Mahjoub Y, Boussaid M, Fkih Hassen M, Atrous S, Aissaoui A. Postobstructive pulmonary edema: A fatal complication in suicidal near-hanging. SAGE Open Med Case Rep 2020; 8:2050313X20922712. [PMID: 32547757 PMCID: PMC7249602 DOI: 10.1177/2050313x20922712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/06/2020] [Indexed: 11/17/2022] Open
Abstract
Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.
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Affiliation(s)
| | - Oussama Jaoued
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Yosra Mahjoub
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
| | - Marwa Boussaid
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
| | - Med Fkih Hassen
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Souheil Atrous
- Department of Critical Care, Taher Sfar Hospital, Mahdia, Tunisia
| | - Abir Aissaoui
- Department of Forensic Medicine, Taher Sfar Hospital, Mahdia, Tunisia
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17
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Hasoon J, Orhurhu V, Urits I. Negative pressure pulmonary edema following laryngospasm. Saudi J Anaesth 2020; 14:265-266. [PMID: 32317893 PMCID: PMC7164444 DOI: 10.4103/sja.sja_604_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
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Goh KJ, Koh MS, Tay CK. The Aftermath of Relieving an Upper Airway Obstruction. A Case of Postobstructive Pulmonary Edema. Am J Respir Crit Care Med 2019; 198:e106-e108. [PMID: 30040910 DOI: 10.1164/rccm.201712-2448im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chee Kiang Tay
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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19
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Louro LF, Raszplewicz J, Hodgkiss‐Geere H, Pappa E. Postobstructive negative pressure pulmonary oedema in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luís Filipe Louro
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Joanna Raszplewicz
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Hannah Hodgkiss‐Geere
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Eirini Pappa
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
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20
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Moser JJ, O'Connell M, McAllister DL. Case Report: Post obstructive pulmonary edema (POPE) Type II following elective adenotonsillectomy requiring novel use of high frequency oscillatory ventilation (HFOV). F1000Res 2019; 7:1373. [PMID: 30647908 PMCID: PMC6325615 DOI: 10.12688/f1000research.16044.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
This case report describes a previously healthy 14 year-old patient undergoing elective outpatient adenotonsillectomy that was complicated by acute postoperative pulmonary edema requiring 12 hours of high frequency oscillatory ventilation (HFOV) support. We describe the clinical findings that led us to this rare diagnosis and management of post obstructive pulmonary edema (POPE) Type II, a rare but recognized complication following the surgical relief of an upper airway obstruction. This case is unique in that no previously published case report or review of POPE Type II has described the need for HFOV support.
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Affiliation(s)
- Joanna J Moser
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, T2N 2T9, Canada
| | - Meghan O'Connell
- Department of Anesthesiology, Pain, and Perioperative Medicine, Royal Jubilee and Victoria General Hospitals, Victoria, British Columbia, V8R 1J8, Canada
| | - Debbie L McAllister
- Department of Pediatric Anesthesia, Alberta Children's Hospital, Calgary, Alberta, T3B 6A8, Canada
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21
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Downing F, Gibson S. Anaesthesia of brachycephalic dogs. J Small Anim Pract 2018; 59:725-733. [PMID: 30374971 DOI: 10.1111/jsap.12948] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 06/07/2018] [Accepted: 09/22/2018] [Indexed: 12/27/2022]
Abstract
Brachycephalic breeds of dog have grown in popularity in the UK and so form an increasing proportion of cases requiring anaesthesia. These breeds are predisposed to several conditions, notably brachycephalic obstructive airway syndrome and gastro-oesophageal reflux, that have important implications for anaesthetic management and carry high risk for complications. This review incorporates peer-reviewed veterinary literature with clinical experience in a discussion on perioperative management of brachycephalic dogs. We focus on preoperative identification of common concurrent conditions, practical strategies for reducing anaesthetic risk and improving postoperative management. Comparisons of brachycephalic obstructive airway syndrome with the human condition of obstructive sleep apnoea are included where appropriate.
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Affiliation(s)
- F Downing
- Davies Veterinary Specialists, Herts, SG5 3HR, UK
| | - S Gibson
- Davies Veterinary Specialists, Herts, SG5 3HR, UK
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22
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Chen Y, Zhang X. Acute Postobstructive Pulmonary Edema Following Laryngospasm in Elderly Patients: A Case Report. J Perianesth Nurs 2018; 34:250-258. [PMID: 30100095 DOI: 10.1016/j.jopan.2018.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Only a few cases regarding postobstructive pulmonary edema following laryngospasm in older patients aged more than 60 years have been reported; however, acute pulmonary edema or pulmonary hemorrhage would be more deadly to elderly patients who have cerebrovascular disease than young healthy adults. After review of the literature, we report an unusual case of a 67-year-old man with ischemic cerebrovascular disease, who underwent carotid angioplasty and stenting and experienced severe pulmonary edema and hemorrhage secondary to laryngospasm after general anesthesia with laryngeal mask airway. The patient required positive-pressure ventilation, supportive treatment, and active cerebroprotection in the intensive care setting for 3 days before the edema resolved, and subsequently made a complete recovery without new onset of neurologic sequelae. The possible pathophysiological mechanisms, precaution, and preventative strategy of postobstructive pulmonary edema in older patients are discussed.
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23
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Alonso JV, Tucker S, Lakshmanan G, Stokes A. Dover sole. Am J Emerg Med 2018; 36:1321.e5-1321.e6. [PMID: 29602671 DOI: 10.1016/j.ajem.2018.03.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/25/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a clinical syndrome well described in the literature and easy to recognize in cases of suspicion, but probably underdiagnosed. It can be a cause of morbidity and admission to the intensive care unit of healthy young individuals. It is present in approximately one in every thousand anesthetics and in 10% of the episodes of upper airway obstruction that are observed in routine clinical practice. It is a non-cardiogenic form of pulmonary oedema thought to be caused by the highly negative intra-thoracic pressure generated when trying to breathe against an acute obstruction. We report a case of NPPE after an airway obstruction in a young male patient.
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Affiliation(s)
- Joaquín Valle Alonso
- Department of Emergency Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK.
| | - Shane Tucker
- Department of Emergency Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
| | | | - Adam Stokes
- Department of Anesthetics, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
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24
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Ballard D, Ferzli G, Kaplowitz L, Chernichenko N, Goldstein NA. Spontaneous hematoma caused by arteriovenous malformation of the hyoid bone: A case report. INT J PEDIAT OTO CAS 2018. [DOI: 10.1016/j.pedeo.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Williams H. The central nervous system pressure histogram in hydrocephalus and hydromyelia. Med Hypotheses 2017; 108:117-123. [DOI: 10.1016/j.mehy.2017.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022]
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26
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Tebay A, Bouti K, Tebay N. [Negative pressure pulmonary edema following a cholecystectomy - A case report]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:267-271. [PMID: 29054715 DOI: 10.1016/j.pneumo.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/13/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
Negative pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema (POPE) is a rare but a life threatening respiratory situation. The most frequent cause of NPPE is a post anesthetic laryngospasm. Edema is developed after relief of upper airway obstruction. Its incidence is 0.1 % of general anesthesia with tracheal intubation. We report this clinical case of a 28-year-old woman, who developed dyspnea followed by acute respiratory distress with unilateral pulmonary edema after extubation following general anesthesia for cholecystectomy under celioscopy. After elimination of any other cause, context, clinical and radiological characteristics, and the favorable evolution under oxygen and furosemide made it possible for us to link this acute respiratory distress to a NPPE whose pathophysiological causes and mechanisms are discussed.
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Affiliation(s)
- A Tebay
- Pratique libérale, Tétouan, Maroc
| | - K Bouti
- Centre de diagnostic et de traitement des maladies respiratoires, rue Sidi-Al-Mandri, 93000 Tétouan, Maroc.
| | - N Tebay
- Centre hospitalier universitaire Ibn-Sina, Rabat, Maroc
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27
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Abstract
Although the lungs are a critical component of exercise performance, their response to exercise and other environmental stresses is often overlooked when evaluating pulmonary performance during high workloads. Exercise can produce capillary leakage, particularly when left atrial pressure increases related to left ventricular (LV) systolic or diastolic failure. Diastolic LV dysfunction that results in elevated left atrial pressure during exercise is particularly likely to result in pulmonary edema and capillary hemorrhage. Data from race horses, endurance athletes, and triathletes support the concept that the lungs can react to exercise and immersion stress with pulmonary edema and pulmonary hemorrhage. Immersion in water by swimmers and divers can also increase stress on pulmonary capillaries and result in pulmonary edema. Swimming-induced pulmonary edema and immersion pulmonary edema in scuba divers are well-documented events caused by the fluid shifts that occur with immersion, elevated pulmonary venous pressure during extreme exercise, and negative alveolar pressure due to inhalation resistance. Prevention strategies include avoiding extreme exercise, avoiding over hydration, and assuring that inspiratory resistance is minimized.
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Affiliation(s)
- Alfred A Bove
- Temple University School of Medicine, Philadelphia, Pennsylvania
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28
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Hua A, Shah KH, Garg M, Legome E, Ufberg J. A Hanging and Its Complications. J Emerg Med 2016; 51:691-696. [DOI: 10.1016/j.jemermed.2016.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022]
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29
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Lee JH, Lee JH, Lee MH, Cho HO, Park SE. Postoperative negative pressure pulmonary edema following repetitive laryngospasm even after reversal of neuromuscular blockade by sugammadex: a case report. Korean J Anesthesiol 2016; 70:95-99. [PMID: 28184275 PMCID: PMC5296396 DOI: 10.4097/kjae.2017.70.1.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/27/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022] Open
Abstract
Laryngospasm, an occlusion of the glottis, can occur at any time during anesthesia, and is associated with serious perioperative complications such as hypoxia, hypercabia, aspiration, bronchospasm, arrhythmia, prolonged recovery, cardiac collapse, and eventually catastrophic death. Importantly, postoperative negative pressure pulmonary edema (NPPE) is a rare, but well described life-threatening complication related to acute and chronic upper airway obstruction. Sugammadex well known for affirmatively reducing the postoperative pulmonary complications associated with residual neuromuscular blockade may have an indirect role in triggering the negative intrathoracic pressure by raising a rapid and efficacious respiratory muscle strength in acute upper airway obstruction. Herein, we report a case of postoperative NPPE following repetitive laryngospasm even after reversal of rocuronium-induced neuromuscular blockade using sugammadex.
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Affiliation(s)
- Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Ho Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Hyun Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyun Oh Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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30
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Glisenti P, Rakusa J, Albrecht R, Luedi MM. Negative pressure pulmonary oedema with haemorrhage after 5-minute avalanche burial. Lancet 2016; 388:2321-2322. [PMID: 27825509 DOI: 10.1016/s0140-6736(16)31010-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paolo Glisenti
- Swiss Air Rescue Rega, Helicopter Base 9, Samedan, Switzerland.
| | - Julia Rakusa
- Department of Internal Medicine, Spital Oberengadin, Samedan, Switzerland
| | - Roland Albrecht
- Swiss Air Rescue Rega, Helicopter Base 9, Samedan, Switzerland
| | - Markus M Luedi
- Swiss Air Rescue Rega, Helicopter Base 9, Samedan, Switzerland; Department of Anaesthesiology and Pain Medicine, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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31
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Bhattacharya M, Kallet RH, Ware LB, Matthay MA. Negative-Pressure Pulmonary Edema. Chest 2016; 150:927-933. [DOI: 10.1016/j.chest.2016.03.043] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 01/11/2023] Open
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32
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Choi HL, Min JH, Kang JH, Kim H, Park JS. Postobstructive pulmonary edema that developed immediately after emergency surgical cricothyroidotomy. Am J Emerg Med 2016; 34:936.e1-2. [DOI: 10.1016/j.ajem.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 12/14/2022] Open
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33
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34
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More PG, Durve SR. Acute Pulmonary Oedema: A Post-Operative Complication Due to Neostigmine and Post Obstructive Pulmonary Oedema in a Case of Tonsillectomy. J Clin Diagn Res 2015; 9:UD05-6. [PMID: 26266194 DOI: 10.7860/jcdr/2015/13072.6067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/04/2015] [Indexed: 11/24/2022]
Abstract
Acute pulmonary oedema has been described in relation to perioperative period. The aetiology may be multifactorial and its management poses a challenge to the anaesthesiologist. Its occurrence in a normal healthy person with no other medical history makes the diagnosis difficult. The causes of pulmonary oedema are cardiac failure, fluid overload, airway obstruction, acid aspiration, gas embolism, anaesthetic drugs, sepsis, anaphylactic reaction and reaction to blood & blood products. Early detection, prompt management by an anaesthesiologist will help to prevent further postoperative complications. We report a case of 9-year-old male child, posted for tonsillectomy under general anaesthesia, who developed acute pulmonary oedema following extubation after reversal with neostigmine and how we managed it successfully.
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Affiliation(s)
- Preeti G More
- Associate Professor, Department of Anaesthesiology, ESI-PGIMSR MGM Hospital , Mumbai, Maharashtra, India
| | - Shubhada R Durve
- Ex- Professor, Department of Anaesthesiology, K.J.Somaiya Medical College and Research Centre , Mumbai, Maharashtra, India
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35
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Percutaneous Transtracheal Jet Ventilation with Various Upper Airway Obstruction. BIOMED RESEARCH INTERNATIONAL 2015; 2015:454807. [PMID: 26161402 PMCID: PMC4486476 DOI: 10.1155/2015/454807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022]
Abstract
A "cannot-ventilate, cannot-intubate" situation is critical. In difficult airway management, transtracheal jet ventilation (TTJV) has been recommended as an invasive procedure, but specialized equipment is required. However, the influence of upper airway resistance (UAR) during TTJV has not been clarified. The aim of this study was to compare TTJV using a manual jet ventilator (MJV) and the oxygen flush device of the anesthetic machine (AM). We made a model lung offering variable UAR by adjustment of tracheal tube size that can ventilate through a 14-G cannula. We measured side flow due to the Venturi effect during TTJV, inspired tidal volume (TVi), and expiratory time under various inspiratory times. No Venturi effect was detected during TTJV with either device. With the MJV, TVi tended to increase in proportion to UAR. With AM, significant variations in TVi was not detected with changes in any UAR. In conclusion, UAR influenced forward flow of TTJV in the model lung. The influence of choked flow from the Venturi effect was minimal under all UAR settings with the MJV, but the AM could not deliver sufficient flow.
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36
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Bouhabba N, Bensghir M, Fjouji S, Azendour H, Haimeur C. [Acute post surgical lung edema: a severe complication]. Pan Afr Med J 2015; 20:229. [PMID: 26140072 PMCID: PMC4482528 DOI: 10.11604/pamj.2015.20.229.5840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/05/2015] [Indexed: 11/16/2022] Open
Abstract
L’œdème aigu pulmonaire (OAP) post-obstructif est une complication respiratoire grave qui doit être reconnue par les anesthésistes et les réanimateurs a fin de permettre une prise en charge diagnostique et thérapeutique précoce. Nous rapportons un cas survenu chez un jeune patient en postopératoire d'une appendicectomie. Immédiatement après l'extubation le patient a développé une détresse respiratoire, une désaturation et des signes auscultatoires et radiologiques évoquant un œdème aigu du poumon. Un bilan étiologique, notamment cardiaque, est revenu normal et l’évolution était favorable dans les heures qui suivent après reintubation et traitement par diurétiques. Le diagnostic de l'OAP post-obstructif était alors retenu. A travers ce cas et une revue de la littérature, les auteurs mettent en relief cette complication redoutable nécessitant une prise en charge précoce.
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Affiliation(s)
- Najib Bouhabba
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Mustapha Bensghir
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Salaheddine Fjouji
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Hicham Azendour
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Charki Haimeur
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
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37
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Smyth R, Canavan M, Bell M, Rutherford R. Pulmonary oedema: an unusual aetiology. Respiration 2015; 89:414-5. [PMID: 25823543 DOI: 10.1159/000375465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert Smyth
- Respiratory Medicine, Galway University Hospitals, Galway, Ireland
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38
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Masuda A, Asano F, Tsuzuku A, Sobajima T, Murakami A, Matsuno Y, Hirata K, Matsunami K, Imamura A. Postobstructive pulmonary edema that developed immediately after the removal of an endobronchial foreign body. Intern Med 2015; 54:497-502. [PMID: 25758077 DOI: 10.2169/internalmedicine.54.3027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 5-year-old boy who was transported to our hospital for a paroxysmal cough, disturbance of consciousness, tonic-clonic convulsions and labored breathing. The patient's respiratory failure persisted after the convulsions remitted, and the presence of an endobronchial foreign body was suspected based on the findings of chest CT performed the following day. A peanut was subsequently removed from the right main bronchus using a bronchoscope with tracheal intubation and bag valve mask ventilation. Immediately after removal, the patient rapidly developed exacerbated hypoxemia, and a reduction in right lung lucency was noted on chest radiography. He was therefore diagnosed with type II postobstructive pulmonary edema, and his condition improved within a short period of time.
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Affiliation(s)
- Atsunori Masuda
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan
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39
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Galster KT, Mills LD, Silva FR. Postobstructive pulmonary edema in the setting of aspiration and air travel. J Emerg Med 2014; 47:e143-6. [PMID: 25281173 DOI: 10.1016/j.jemermed.2014.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 07/11/2014] [Accepted: 07/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postobstructive pulmonary edema (POPE)-also referred to as negative pressure pulmonary edema-occurs with deep inspiration against a closed glottis or obstructed airway. The result can be life threatening, however, most cases have a self-limited presentation and resolve with supportive care. OBJECTIVE Our aim was to critically evaluate a previously unreported mechanism in the exacerbation of POPE. CASE REPORT This is a report of a 50-year-old woman who experienced an acute episode of hypoxia and altered mental status aboard a transcontinental flight. Her presentation was suggestive of pulmonary embolus. However, a detailed history yielded an episode of preflight choking relieved by the Heimlich maneuver. After 2 days of supportive care she was discharged with a complete return to baseline. CONCLUSIONS Subclinical cases of POPE can be exacerbated by the low atmospheric pressure experienced on commercial airlines. With early recognition and supportive treatment, the patient returned to baseline before her discharge 2 days later. Making the diagnoses of POPE is not always straightforward for the practitioner and necessitates a broad differential. Initial supportive care focusing on maximizing respiratory support is critical.
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Affiliation(s)
- Kellen T Galster
- Albany Medical College, Albany, New York; University of Nevada, Department of Emergency Medicine, Las Vegas, Nevada
| | - Lisa D Mills
- UC Davis Medical Center, Department of Emergency Medicine, Sacramento, California
| | - Fernando R Silva
- UC Davis Medical Center, Department of Emergency Medicine, Sacramento, California
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40
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Pavlidou K, Savvas I, Moens Y, Vasilakos D, Raptopoulos D. A minimally invasive method for clinical trans-diaphragmatic pressure measurement in anaesthetized dogs. Vet Anaesth Analg 2014; 41:278-83. [DOI: 10.1111/vaa.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/19/2013] [Indexed: 11/30/2022]
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41
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Aknin S, Frappart M, Berguiga R, Malinovsky JM. Hémoptysie et œdème aigu du poumon à pression négative en postopératoire d’une amygdalectomie. ACTA ACUST UNITED AC 2014; 33:178-80. [DOI: 10.1016/j.annfar.2013.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
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42
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Postobstructive Pulmonary Edema in a 40-Year-Old Man after Suffocation by a Swimming Pool Cover. J Emerg Med 2013; 45:670-3. [DOI: 10.1016/j.jemermed.2013.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/18/2013] [Accepted: 04/30/2013] [Indexed: 12/14/2022]
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43
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Pavlidou K, Savvas I, Moens YPS, Vasilakos D, Raptopoulos D. The effect of four anaesthetic protocols for maintenance of anaesthesia on trans-diaphragmatic pressure in dogs. PLoS One 2013; 8:e75341. [PMID: 24124482 PMCID: PMC3790779 DOI: 10.1371/journal.pone.0075341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/13/2013] [Indexed: 12/05/2022] Open
Abstract
The diaphragm is the main inspiratory muscle and the main indicator of diaphragmatic contractility is the trans-diaphragmatic pressure (Pdi). The aim of this clinical study was to determine the effect of four different anaesthetic protocols on Pdi in anaesthetized healthy dogs. Eighty client-owned dogs were recruited in this clinical study. All the animals received dexmedetomidine and morphine as premedication and propofol for induction. Anaesthesia was maintained with one of four protocols: isoflurane (I), isoflurane with CRI of propofol (IP), isoflurane with CRI of fentanyl (IF), and isoflurane with CRI of ketamine (IK). When the surgical plane of anaesthesia was achieved, two balloon catheters were inserted, one into the stomach and one into the mid-third of the oesophagus for Pdi measurement. Pdi value was the highest in groups I (14.9±4.7 mmHg) and IK (15.2±3.5 mmHg) and the lowest in groups IP (12.2±3.2 mmHg) and IF (12.0±5.9 mmHg). There was a statistically significant difference (p = 0.029) between groups IK and IF. PE’CO2 was statistically significantly higher (p<0.0005) in group IF (7.7±0.8 kPa) than in group IK (6.5±0.7 kPa). Isoflurane alone or isoflurane with ketamine for the maintenance of anaesthesia seem to better preserve the respiratory function and the diaphragmatic contractility than isoflurane with either propofol or fentanyl in dogs. Therefore, the use of isoflurane or isoflurane with ketamine may be of benefit when animals with respiratory problems have to be anaesthetized.
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Affiliation(s)
- Kiriaki Pavlidou
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Savvas
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- * E-mail:
| | - Yves P. S. Moens
- Anaesthesiology and Perioperative Intensive Care, Veterinary University, Vienna, Austria
| | - Dimitrios Vasilakos
- Anaesthesiology and ICU Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Raptopoulos
- Anaesthesiology and Intensive Care Unit, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Berdai AM, Labib S, Harandou M. Postobstructive pulmonary edema following accidental near-hanging. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:350-3. [PMID: 24023977 PMCID: PMC3767585 DOI: 10.12659/ajcr.889415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/27/2013] [Indexed: 12/18/2022]
Abstract
PATIENT Female, 14 FINAL DIAGNOSIS: Postobstructive pulmonary edenma Symptoms: Chest indrawing • bilateral pulmonary crepitations • tachypnea MEDICATION - Clinical Procedure: Controlled ventilatory support • positive end expiratory pressure Specialty: Intensive care. OBJECTIVE Unusual clinical course. BACKGROUND Postobstructive pulmonary edema (POPE) is a life-threatening complication that occurs after the relief of an upper airway obstruction. POPE occurs rarely in children, primarily after non-lethal hanging. CASE REPORT We report the case of a 14-year-old girl who developed POPE after accidental near hanging. She had chest in-drawing, the SpO2 was 81% on room air, and pulmonary auscultation revealed bilateral crepitations. The chest x-ray showed bilateral diffuse infiltrates consistent with pulmonary edema. The intensive care management consisted of controlled ventilatory support with high-level positive end expiratory pressure. On the third day of hospitalization, the patient was weaned from the ventilator and extubated with a full recovery. CONCLUSIONS This case confirms the importance of early recognition of POPE and the value of adapted treatment, which can lead to a favorable outcome and full recovery in cases of near hanging.
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Chang KC, Li HY. Postobstructive pulmonary edema (POPE) after surgery for obstructive sleep apnea. Kaohsiung J Med Sci 2013; 29:284-5. [PMID: 23639517 DOI: 10.1016/j.kjms.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Liu PY, Shih ML, Chen CW. Postobstructive pulmonary edema associated with a substernal goitre. CMAJ 2012; 184:2011-4. [PMID: 23027909 DOI: 10.1503/cmaj.120256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Pang-Yen Liu
- Departments Of Internal Medicine, Tri-Service General Hospital, National defense MedicalCenter, Taipei, Taiwan.
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Vandse R, Kothari DS, Tripathi RS, Lopez L, Stawicki SPA, Papadimos TJ. Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities. Int J Crit Illn Inj Sci 2012; 2:98-103. [PMID: 22837897 PMCID: PMC3401823 DOI: 10.4103/2229-5151.97275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.
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Affiliation(s)
- Rashmi Vandse
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, Ohio, USA
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48
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Manne JR, Kasirye Y, Epperla N, Garcia-Montilla RJ. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: short review of the pathophysiology and diagnostic approach. Clin Med Res 2012; 10:131-6. [PMID: 22031475 PMCID: PMC3421372 DOI: 10.3121/cmr.2011.1030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute pulmonary edema complicating electroconvulsive therapy is an extremely uncommon event that has rarely been described in the literature. Different theories, including one suggesting a cardiogenic component, have been proposed to explain its genesis. The present report describes a classic presentation of this condition with review of its potential mechanisms and diagnostic approach. After successful completion of a session of electroconvulsive therapy, a 42-year-old woman with major depressive disorder developed acute systemic high blood pressure, shortness of breath, and hemoptysis. A chest radiograph demonstrated diffuse bilateral pulmonary infiltrates. Initially cardiogenic pulmonary edema was presumed, but an extensive diagnostic work-up demonstrated normal systolic and diastolic left ventricular function, and with only supportive measures, a complete clinical and radiographic recovery was achieved within 48 hours. The present case does not support any cardiogenic mechanism in the genesis of this condition.
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Affiliation(s)
- Janaki R Manne
- Department of Hospital Medicine, Marshfield Clinic, Marshfield, WI 54449, USA.
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Boon M, Proesmans M, De Boeck K. Hemoptysis after orthopedic surgery in an adolescent boy. Pediatr Pulmonol 2012; 47:623-5. [PMID: 22038784 DOI: 10.1002/ppul.21585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/29/2011] [Indexed: 11/07/2022]
Abstract
In children, post-obstructive pulmonary edema is a rare condition, caused by a sudden change in upper airway patency. It causes dyspnea, tachypnea, hypoxemia, and at times hemoptysis and respiratory insufficiency. It occurs as a complication in the immediate post-operative period. Pediatricians should be aware of this clinical entity.
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Affiliation(s)
- M Boon
- Paediatric Department, Pediatric Pulmonology, University of Leuven, Leuven, Belgium.
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Lin CS, Hung CJ, Lin FS, Chan WH. Constriction of an endotracheal tube by a nasogastric tube during general anesthesia resulting in pulmonary edema. J Cardiothorac Vasc Anesth 2012; 26:e37-8. [PMID: 22445182 DOI: 10.1053/j.jvca.2012.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Indexed: 11/11/2022]
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