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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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Cerna-Viacava R, Almajed MR, Pinto Corrales J. An Internist's Approach to a Case of Negative Pressure Pulmonary Edema: A Rare Cause of Noncardiogenic Pulmonary Edema. Cureus 2023; 15:e39587. [PMID: 37384099 PMCID: PMC10293915 DOI: 10.7759/cureus.39587] [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: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
Negative-pressure pulmonary edema (NPPE) is a rare cause of noncardiogenic pulmonary edema, which usually presents postoperatively. Its pathophysiology is mostly described as a profound negative intrathoracic pressure caused by an airway obstruction such as laryngospasm, which may occur during extubation. But, there are other hypotheses about it, such as catecholamines release causing an elevated hydrostatic pressure in the cardiopulmonary circuit and, consequently, a major capillary leak to the interstitium. Its natural course varies, from prompt recovery to intensive care unit escalation and prolonged mechanical ventilation. Although anesthesiologists often detect this condition, this case's objective is to bring awareness of this condition to internists as a potential differential diagnosis for hypoxia in the postoperative setting.
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Kim JH, Kim Y, Yoo K, Kim M, Kang SS, Kwon YS, Lee JJ. Prediction of Postoperative Pulmonary Edema Risk Using Machine Learning. J Clin Med 2023; 12:jcm12051804. [PMID: 36902590 PMCID: PMC10003313 DOI: 10.3390/jcm12051804] [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: 01/30/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Postoperative pulmonary edema (PPE) is a well-known postoperative complication. We hypothesized that a machine learning model could predict PPE risk using pre- and intraoperative data, thereby improving postoperative management. This retrospective study analyzed the medical records of patients aged > 18 years who underwent surgery between January 2011 and November 2021 at five South Korean hospitals. Data from four hospitals (n = 221,908) were used as the training dataset, whereas data from the remaining hospital (n = 34,991) were used as the test dataset. The machine learning algorithms used were extreme gradient boosting, light-gradient boosting machine, multilayer perceptron, logistic regression, and balanced random forest (BRF). The prediction abilities of the machine learning models were assessed using the area under the receiver operating characteristic curve, feature importance, and average precisions of precision-recall curve, precision, recall, f1 score, and accuracy. PPE occurred in 3584 (1.6%) and 1896 (5.4%) patients in the training and test sets, respectively. The BRF model exhibited the best performance (area under the receiver operating characteristic curve: 0.91, 95% confidence interval: 0.84-0.98). However, its precision and f1 score metrics were not good. The five major features included arterial line monitoring, American Society of Anesthesiologists physical status, urine output, age, and Foley catheter status. Machine learning models (e.g., BRF) could predict PPE risk and improve clinical decision-making, thereby enhancing postoperative management.
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Affiliation(s)
- Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
| | - Youngmi Kim
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
| | - Kookhyun Yoo
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
| | - Minguan Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
| | - Seong Sik Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon-si 24341, Republic of Korea
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
- Correspondence: (Y.-S.K.); (J.J.L.); Tel.: +82-33-240-5271 (Y.-S.K. & J.J.L.)
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
- Correspondence: (Y.-S.K.); (J.J.L.); Tel.: +82-33-240-5271 (Y.-S.K. & J.J.L.)
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Wirtz A. Return to Sport From Viral Myocarditis in a Previously Healthy Collegiate Athlete: A Case Report. J Athl Train 2023; 58:153-155. [PMID: 35622944 PMCID: PMC10072089 DOI: 10.4085/1062-6050-0458.21] [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: 11/09/2022]
Abstract
The objective of this paper is to present the case of a healthy, 19-year-old female collegiate soccer player who developed acute pulmonary edema and acute heart failure in the recovery room after hip labral arthroscopic surgery. The patient's initial diagnosis, of negative pressure pulmonary edema in direct relation to extubation, was questioned when she became hemodynamically unstable. A cardiac biopsy revealed acute pulmonary edema and heart failure secondary to viral myocarditis. The patient was treated and discharged 10 days after admission. Specific and substantiated return-to-play guidelines after a cardiac event, specifically viral myocarditis, have been sparse. The interprofessional collaboration between athletic trainers and cardiologists is a key dynamic in the clinical decision-making process of a safe return to competitive athletic participation after a cardiac event.
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Affiliation(s)
- Abigail Wirtz
- Athletics and Recreation Department, Endicott College, Beverly, MA
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Matsuo M, Takemura Y, Yamazaki M. Limited Utility of Routine Tests Prior to Ophthalmologic Surgery: An Observational Study in a Japanese Hospital. JMA J 2021; 4:270-276. [PMID: 34414322 PMCID: PMC8355728 DOI: 10.31662/jmaj.2020-0112] [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: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Routine preoperative testing for low-risk surgeries without a clinical indication should be avoided; however, such tests are still frequently performed in Japan. This study was performed to assess the impact of routine preoperative tests in low-risk surgery in a Japanese medical setting. Methods: We performed a retrospective chart review to examine the utility of routine tests with respect to anesthetic management and postoperative complications in all patients aged ≥ 18 years whom ophthalmologists consulted with anesthesiologists before ophthalmologic surgery under general anesthesia. Results: During the 10-year study period, 1,234 anesthetic consultations and 1,211 routine preoperative tests (laboratory tests, chest X-rays, and electrocardiograms) were performed in Toyama University Hospital. In total, 59 patients (4.8% of the study population) canceled surgery after a battery of preoperative evaluation. Among them, 10 patients had incidental abnormalities that necessitated additional tests, and only three patients (0.2%) canceled surgery. In-hospital postoperative complications developed in nine patients (0.7%) whose routine test results made it difficult to predict development of these adverse events. No severe life-threatening events were noted in this survey. Conclusions: Routine tests prior to eye surgery for adults were of low value for perioperative management and prediction of development of in-hospital complications in this Japanese medical setting. Anesthesiologists and ophthalmologists should selectively order preoperative tests based on the medical interview and physical examination.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshinori Takemura
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mitsuaki Yamazaki
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
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Tsuchiya N, Griffin L, Yamashiro T, Gibo S, Okane T, Yasutani T, Murayama S. Imaging findings of pulmonary edema: Part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol 2020; 61:195-203. [PMID: 31237773 DOI: 10.1177/0284185119856880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsay Griffin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Shinji Gibo
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | - Tsuyoshi Okane
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Cossu A, Martin Rother MD, Kusmirek JE, Meyer CA, Kanne JP. Imaging Early Postoperative Complications of Cardiothoracic Surgery. Radiol Clin North Am 2020; 58:133-150. [DOI: 10.1016/j.rcl.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tsai PH, Wang JH, Huang SC, Lin YK, Lam CF. Characterizing post-extubation negative pressure pulmonary edema in the operating room-a retrospective matched case-control study. Perioper Med (Lond) 2018; 7:28. [PMID: 30534363 PMCID: PMC6282297 DOI: 10.1186/s13741-018-0107-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/10/2018] [Indexed: 12/27/2022] Open
Abstract
Background Post-extubation negative pressure pulmonary edema (NPPE) is an uncommon but important anesthesia-related emergency presenting with acute respiratory distress and hypoxemia after removal of airway devices. This study investigated the incidence and associated risk factors for post-extubation NPPE during emergence. Methods This retrospective, matched case-control study was conducted by reviewing the post-anesthesia records in Tzu Chi General Hospital, Taiwan. Patients reported of having acute hypoxemia (SpO2 < 92%) shortly after the removal of the endotracheal tube or supraglottic airway, associating with radiographic evidence of pulmonary edema and/or pink frothy sputum, were identified as definite NPPE cases. The potential risk factors were compared with the matched controls, who were randomly selected from the same database. Results A total of 85,561 patients received general anesthesia with airway instrumentation during the 8.5-year study period. A total of 16 patients were identified as definite cases of NPPE. Compared with the matched controls (n = 131), males, active smokers, emergency operation, endotracheal intubation, use of desflurane, and prolonged operation time carried significantly higher risks of developing NPPE (P < 0.05). Multivariate logistic regression analysis illustrated that active smoking (AOR 7.66, 95% CI 1.67–35.3; P = 0.009) and endotracheal intubation (AOR 10.87, 95% CI 1.23–100; P = 0.03) were the two most significant independent variables of post-extubation NPPE. Conclusion We present the first clinical comparative study demonstrating that the overall incidence of NPPE immediately after extubation in the operating room is 0.019%. Our results highlight that active smokers and patients receiving endotracheal intubation general anesthesia are associated with significantly higher risks of developing NPPE following extubation in the operating room. Electronic supplementary material The online version of this article (10.1186/s13741-018-0107-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pei-Hsin Tsai
- 1Department of Anesthesiology, E-Da Hospital/E-Da Cancer Hospital, I-Shou University, No 1, Yida Road. Yanchao Dist., Kaohsiung city, 824 Taiwan.,2Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- 3Department of Medical Research, Tzu Chi General Hospital, Hualien, Taiwan
| | - Shian-Che Huang
- 1Department of Anesthesiology, E-Da Hospital/E-Da Cancer Hospital, I-Shou University, No 1, Yida Road. Yanchao Dist., Kaohsiung city, 824 Taiwan
| | - Yen-Kuang Lin
- 4Biostatistics Center, Taipei Medical University, Taipei, Taiwan
| | - Chen-Fuh Lam
- 1Department of Anesthesiology, E-Da Hospital/E-Da Cancer Hospital, I-Shou University, No 1, Yida Road. Yanchao Dist., Kaohsiung city, 824 Taiwan
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Han IS, Han BM, Jung SY, Yoon JR, Chung EY. Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period. Acute Crit Care 2018; 33:191-195. [PMID: 31723885 PMCID: PMC6786702 DOI: 10.4266/acc.2016.00689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023] Open
Abstract
Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.
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Affiliation(s)
- In Soo Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Mi Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Jung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Rho Yoon
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Yong Chung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Ricardo J, José Anaya M, Barbosa M, André N, Magno P, Morais J, Proença G, Rabaçal C, Gil V. A rare form of acute pulmonary edema: Case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2174-2049(11)70029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Forma rara de edema pulmonar agudo: a propósito de um caso clínico. Rev Port Cardiol 2011; 30:799-801. [DOI: 10.1016/s0870-2551(11)70029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/11/2011] [Indexed: 11/21/2022] Open
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