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Dewilde M, Lutin B. A Case of Postoperative Noncardiogenic Edema: Negative Pressure Pulmonary Edema. J Belg Soc Radiol 2024; 108:67. [PMID: 38974911 PMCID: PMC11225549 DOI: 10.5334/jbsr.3551] [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] [Received: 03/15/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
A case of complete recovery of negative pressure pulmonary edema after a Cottle surgery in a 24-year-old male. Teaching point: Negative pressure pulmonary edema is an important cause of postoperative noncardiogenic edema, with the spontaneous disappearance of all complaints within a relatively short period.
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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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Befikadu A, Timerga S, Mihretu F, Wonte MM. Negative pressure plmonary oedema after adenotonsillectom: a case report and litrature review. Ann Med Surg (Lond) 2024; 86:2236-2241. [PMID: 38576921 PMCID: PMC10990353 DOI: 10.1097/ms9.0000000000001790] [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: 12/05/2023] [Accepted: 01/25/2024] [Indexed: 04/06/2024] Open
Abstract
Background Negative pressure pulmonary is a non-cardiogenic pulmonary oedema that can occur after reliving of upper airway obstruction. It is life threatening clinical scenario developed due to increase intrathoracic pressure during marked inspiratory effort against a closed glottis. Case presentation A successful adenotonsillectomy was done for a healthy 12-year-old, 33 kg male patient and transferred to post-anaesthesia care unit. In the unit the patient developed signs and symptoms of negative pressure pulmonary oedema so he was treated with diuretics and oxygen while restricting fluid. However, the dyspnoea was persisted so he was transferred to ICU. Clinical discussion This case report shows the development of negative pressure pulmonary oedema after adenotonsillectomy. In this report the clinical presentation, diagnosis, treatment, prevention and prognosis of negative pressure pulmonary oedema after adenotonsillectomy was discussed in detail with citing updated evidences. Conclusions Post-extubation pulmonary oedema can occur after reliving of chronic air obstruction. Usually it occur within 5 min after reliving the obstruction but it can occur at any time. All healthcare professionals must be knowledgeable about clinical presentation and managements of negative pressure pulmonary oedema.
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Affiliation(s)
- Aynalem Befikadu
- Wollo University, College of Health Science and Medicine, Department of Anesthesia, Wollo, Dessie
| | - Sara Timerga
- Wollo University, College of Health Science and Medicine, Department of Anesthesia, Wollo, Dessie
| | - Fasil Mihretu
- Wollo University, College of Health Science and Medicine, Department of Anesthesia, Wollo, Dessie
| | - Mesay Milkias Wonte
- Dilla University, College of Health Sciences and Medicine, Department of Anesthesiology, Dilla, Ethiopia
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Deng X, Yang CY, Zhu ZL, Tian W, Tian JX, Xia M, Pan W. Negative pressure pulmonary edema after laparoscopic cholecystectomy: A case report and literature review. Medicine (Baltimore) 2024; 103:e37443. [PMID: 38489724 PMCID: PMC10939698 DOI: 10.1097/md.0000000000037443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is an acute onset of non-cardiogenic interstitial pulmonary edema, commonly seen among surgical patients after extubation from general aneasthesia. It is mainly caused by rapid inspiration with acute upper airway obstruction resulting in significant negative thoracic pressure. PATIENT CONCERNS A 24-year-old female patient who underwent laparoscopic cholecystectomy under general anesthesia and developed NPPE postoperatively. DIAGNOSES Her main clinical manifestation was coughing up pink foamy sputum; postoperative CT showed increased texture in both lungs and bilateral ground glass opacities. INTERVENTIONS Diuretics and steroids were used, and symptomatic supportive treatments such as oxygen were given. OUTCOMES After treatment, on the fourth post-operative day, her symptoms were relieved and her vital signs were stable enough for her to be discharged. LESSONS Although this is a rare and severe complication, the prognosis of NPPE is good when it is managed with proper diagnosis and treatment.
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Affiliation(s)
- Xu Deng
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Chun-Yuan Yang
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Zong-Long Zhu
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Jian-Xing Tian
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Ming Xia
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
| | - Wei Pan
- Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Lezhi, Lezhi, China
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Rudman L, Chambi-Torres JB, Chohan F, Aftab M, Cao X, Michel G. A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature. Cureus 2023; 15:e42152. [PMID: 37602134 PMCID: PMC10438953 DOI: 10.7759/cureus.42152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Negative-pressure pulmonary edema (NPPE) is an uncommon diagnosis that requires a high clinical suspicion to recognize and manage and has high morbidity and mortality. It usually results secondary to markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway from upper airway infection, tumor, or laryngospasm. We present a case of a 27-year-old female with morbid obesity who underwent sleeve gastrectomy and developed NPPE upon emergence from anesthesia. The focus of supportive care should be on addressing the obstruction in the upper airway through either endotracheal intubation or cricothyroidotomy. Additionally, it is important to initiate lung-protective positive-pressure ventilation and promote diuresis, unless the patient is in a state of shock. The resolution of pulmonary edema is typically swift, partially due to the preservation of alveolar fluid clearance mechanisms. In the literature review, we delve into the clinical presentation, pathophysiology, and management of NPPE or post-obstructive pulmonary edema.
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Affiliation(s)
- Larri Rudman
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | | | - Farah Chohan
- Research and Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - Mohammad Aftab
- Pulmonary and Critical Care, Larkin Community Hospital, South Miami, USA
| | - Xinyu Cao
- Pulmonary and Critical Care Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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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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Sekimoto Y, Suzuki Y, Kanamori K, Kobayashi I, Ienaga H, Takahashi K. A case of negative-pressure pulmonary oedema after first-time electroconvulsive therapy. Respirol Case Rep 2022; 10:e0956. [PMID: 35582342 PMCID: PMC9086599 DOI: 10.1002/rcr2.956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/15/2022] [Indexed: 11/14/2022] Open
Abstract
Electroconvulsive therapy (ECT) has been used for many years as an important treatment modality in patients with schizophrenia. Recently, many new oral medications have become available to treat schizophrenia. However, ECT remains a valuable therapy for patients who are resistant to oral medications. A 16-year-old girl with schizophrenia was admitted to our hospital with hypoxaemia due to negative-pressure pulmonary oedema (NPPE) after her first ECT. NPPE is an exceedingly rare complication after ECT. However, it can result in serious morbidity if not immediately recognized and treated. This case illustrates the importance of recognizing this rare complication.
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Affiliation(s)
- Yasuhito Sekimoto
- Department of PulmonologyKoshigaya Municipal HospitalKoshigaya CityJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Yoshifumi Suzuki
- Department of PulmonologyKoshigaya Municipal HospitalKoshigaya CityJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Koichiro Kanamori
- Department of PulmonologyKoshigaya Municipal HospitalKoshigaya CityJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Isao Kobayashi
- Department of PulmonologyKoshigaya Municipal HospitalKoshigaya CityJapan
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
| | - Hiroki Ienaga
- Department of PulmonologyKoshigaya Municipal HospitalKoshigaya CityJapan
| | - Kazuhisa Takahashi
- Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
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Sakamoto T, Sato R, Endo A, Iwashita Y, Tanabe K. Negative-Pressure Pulmonary Edema and Takotsubo Cardiomyopathy in the Older Adults. Cureus 2022; 14:e22661. [PMID: 35371635 PMCID: PMC8964023 DOI: 10.7759/cureus.22661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
Negative-pressure pulmonary edema (NPPE) is a non-cardiogenic pulmonary edema caused by a sudden drop in the intrathoracic pressure associated with upper airway obstruction. Takotsubo cardiomyopathy (TCM) can often be triggered by intense stress and is more common in older women. In this case report, we describe a case of NPPE associated with upper airway obstruction and TCM associated with stress by upper airway obstruction in an 85-year-old woman. When encountering pulmonary edema associated with upper airway obstruction in older adults, the possibility of NPPE and TCM complications should be considered.
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Kuramoto K, Matsuyama M, Nonaka M, Takeishi T, Oshima H, Matsumura S, Nakajima M, Sakai C, Shiozawa T, Kiwamoto T, Tsukahara Y, Takayashiki N, Ogawa R, Morishima Y, Noguchi M, Hizawa N. Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea. Intern Med 2021; 60:2291-2296. [PMID: 33612674 PMCID: PMC8355386 DOI: 10.2169/internalmedicine.6206-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 24-year-old man with a history of bloody sputum for 6 months was referred to our hospital with suspected alveolar hemorrhaging due to vasculitis. Chest computed tomography showed ground-glass opacities in both lungs, and an examination of his bronchoalveolar lavage fluid showed alveolar hemorrhaging. However, no evidence of vasculitis was found, and subsequent polysomnographic testing confirmed that he had severe obstructive sleep apnea (OSA). Since the alveolar hemorrhaging improved after the initiation of continuous positive airway pressure treatment, the diagnosis was negative-pressure alveolar hemorrhaging due to severe OSA.
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Affiliation(s)
- Kenya Kuramoto
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masashi Matsuyama
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Mizu Nonaka
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Takahiro Takeishi
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Hisayuki Oshima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Sosuke Matsumura
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masayuki Nakajima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Chio Sakai
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Toshihiro Shiozawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Takumi Kiwamoto
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | | | - Norio Takayashiki
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Ryoko Ogawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Yuko Morishima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
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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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11
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Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy. Case Rep Crit Care 2020; 2020:8830935. [PMID: 33282422 PMCID: PMC7685842 DOI: 10.1155/2020/8830935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022] Open
Abstract
Negative pressure pulmonary edema and hemorrhage are uncommon but potentially life-threatening complications associated with general anesthesia. Postoperative negative pressure pulmonary edema usually occurs immediately after surgery, and delayed-onset cases occurring more than 1 hour after surgery have rarely been reported. A 37-year-old woman with bronchial asthma underwent vocal cord polypectomy under general anesthesia in another hospital and experienced cardiac arrest due to a negative pressure pulmonary hemorrhage occurring 3 hours and 30 minutes after surgery. She was successfully treated with venoarterial extracorporeal membrane oxygenation and completely recovered without any complications. Extraordinary delayed-onset negative pressure pulmonary hemorrhage occurring more than three hours after surgery has rarely been reported. This case may indicate the need for more careful observation of patients following surgery.
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Din-Lovinescu C, Trivedi U, Zhang K, Barinsky GL, Grube JG, Eloy JA, Hsueh WD. Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures. Ann Otol Rhinol Laryngol 2020; 130:245-253. [PMID: 32627567 DOI: 10.1177/0003489420938817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE(S) Negative pressure pulmonary edema (NPPE) is a rare perioperative complication with a potentially fatal outcome. The aim of this study was to perform a systematic review of NPPE in adult otolaryngology procedures with the goal of identifying risk factors, clinical presentation, diagnosis, management and outcomes. METHODS Systematic review performed using PubMed, Scopus, Web of Science, and Cochrane databases. RESULTS Sixty-nine studies including data from 87 individual patients were included in this review. Fifty-six (68%) patients were male and the average patient age was 37 years old. Type 1 NPPE occurred in 63 (72%) cases, while type 2 NPPE accounted for 20 (23%) cases. The most common procedures leading to NPPE were septoplasty, rhinoplasty or sinus surgery (n = 22, 25%), directly laryngoscopy or bronchoscopy (n = 13, 15%), and tracheostomy or cricothyroidotomy (n = 11, 13%). The most employed treatment options included diuretics (n = 55, 63%) and mechanical ventilation (n = 54, 62%). Seventy-eight (90%) patients made a full recovery with an average time to NPPE resolution of 33 hours and an average length of hospitalization of 5.6 days. Five (6%) patients had a long-term morbidity and four (5%) patients died, with age and ICU stay increasing risk for death and long-term morbidity (OR 1.044 and 7.42, respectively, P < .05). CONCLUSION Septoplasty, rhinoplasty and sinus surgery account for the majority of NPPE cases in adult otolaryngology procedures. Young, healthy patients are the most commonly involved with a slight male predominance. The vast majority of patients recover fully, however there is a significant risk for morbidity and mortality.
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Affiliation(s)
- Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Usha Trivedi
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
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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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Abstract
Negative-pressure pulmonary edema (NPPE) is acute-onset bilateral pulmonary interstitial edema. This condition can be caused by significant negative intrathoracic pressure generated by large inspiratory effort against acute upper airway obstruction. Postoperative NPPE is rare but potentially life-threatening if not recognized and treated promptly. This article describes a patient who developed postoperative NPPE following a laparoscopic appendectomy.
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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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16
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Postoperative Pulmonary Edema Conundrum: A Case of Negative Pressure Pulmonary Edema. Case Rep Crit Care 2018; 2018:1584134. [PMID: 30345119 PMCID: PMC6174762 DOI: 10.1155/2018/1584134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
Postobstructive pulmonary edema (POPE) also known as negative pressure pulmonary edema (NPPE) is an underdiagnosed entity in clinical practice and can lead to life-threatening hypoxemia. A 64-year-old male patient's perioperative course was complicated by acute hypoxemic respiratory failure, after extubation following general anesthesia, following the excision of the right vocal cord papilloma. His chest X-ray showed features of pulmonary edema, EKG showed dynamic ST-T changes in the lateral leads, and echocardiography showed evidence of regional motion abnormalities. His coronaries were normal on the immediate angiogram. He was managed with lung protective mechanical ventilation strategy, diuretics, and fluid restriction. His respiratory status improved, and trachea was extubated after 10 hours of intensive care unit (ICU) stay. The case illustrates the various differentials of immediate postoperative flash pulmonary edema and ensuing appropriate management strategy.
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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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Ranta M, Cain AJ, Odutoye B, Mountain RE. Pulmonary Oedema Induced by a Piece of Chicken. J R Soc Med 2017. [DOI: 10.1177/014107680209500809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M Ranta
- Department of Otolaryngology, Head and Neck Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - A J Cain
- Department of Otolaryngology, Head and Neck Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - B Odutoye
- Department of Otolaryngology, Head and Neck Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - R E Mountain
- Department of Otolaryngology, Head and Neck Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
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Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and Preoperative Risk Factors for Major Complications in Aesthetic Rhinoplasty: Analysis of 4978 Patients. Aesthet Surg J 2017; 37:757-767. [PMID: 28472446 DOI: 10.1093/asj/sjx023] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Rhinoplasty remains one of the most common aesthetic procedures performed in the United States. Current literature on rhinoplasty complications is inconclusive and is based on retrospective reviews and small cohorts. Objectives The purpose of this study was to examine the incidence and identify predictive risk factors for major complications following rhinoplasty alone or in combination with other aesthetic operations in a large, prospective, multicenter database study. Methods A prospective cohort of patients undergoing rhinoplasty between May 2008 and May 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications, defined as complications requiring an emergency room visit, hospital admission, or a reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for major complications including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. Results A total of 129,007 patients were identified, of which 4978 (3.9%) underwent a rhinoplasty. The overall complication rate was 0.7% (n = 37). Hematoma was the most common complication (0.2%), followed by infection (0.2%), and pulmonary complications (0.1%). Age ≥40 years was found to be an independent risk factor for developing complications. Age ≥40 years was found to have a relative risk of 2.05 (P = 0.04) for any major complication. Complications increased from 0.58% in rhinoplasty alone cases to 1.02% (P < 0.05) with the addition of 1 other body region to 2.09% with the addition of 2 other body regions (P < 0.05). The risk of pulmonary complications increased from 0.1% to 1% (P < 0.05) with the addition of rhinoplasty with 2 other body regions. Gender, type of facility, smoking status, and BMI ≥25 did not appear to significantly impact the risk for major complications. Conclusions The major complication rate following rhinoplasty remains low. The risk is increased with age ≥40 years and with the addition of other cosmetic procedures. Pulmonary complications, although rare, do occur, and also increase when combining rhinoplasty with other aesthetic surgery. These findings are important to consider when planning rhinoplasty and educating patients on the safety of combined aesthetic surgeries. Level of Evidence 2.
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Affiliation(s)
- John Layliev
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
| | - Varun Gupta
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
| | | | | | - Julian Winocour
- Division of Plastic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
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Contou D, Voiriot G, Djibré M, Labbé V, Fartoukh M, Parrot A. Clinical Features of Patients with Diffuse Alveolar Hemorrhage due to Negative-Pressure Pulmonary Edema. Lung 2017; 195:477-487. [PMID: 28455784 DOI: 10.1007/s00408-017-0011-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Diffuse alveolar hemorrhage (DAH) with negative-pressure pulmonary edema (NPPE) is an uncommon yet life-threatening condition. We aimed at describing the circumstances, clinical, radiological, and bronchoscopic features, as well as the outcome of patients with NPPE-related DAH. METHODS We performed a retrospective, observational cohort study, using data prospectively collected over 35 years in an intensive care unit (ICU). RESULTS Of the 149 patients admitted for DAH, we identified 18 NPPE episodes in 15 patients, one admitted four times for recurrent NPPE-related DAH. The patients were primarily young, male, and athletic. The NPPE setting was postoperative (n = 12/18, 67%) or following generalized tonic-clonic seizures (n = 6/18, 33%). Hemoptysis was almost constant (n = 17/18, 94%), yet rarely massive (>200 cc, n = 1/18, 6%), with anemia observed in 10 (56%) episodes. The DAH triad (hemoptysis, anemia, and pulmonary infiltrates) was observed in 50% of episodes (n = 9/18), and acute respiratory failure in 94% (n = 17/18). Chest computed tomography revealed diffuse bilateral ground glass opacities (n = 10/10, 100%), while bronchoscopy detected bilateral hemorrhage (n = 12/12, 100%) and macroscopically bloody bronchoalveolar lavage, with siderophage absence in most (n = 7/8, 88%), indicating acute DAH. While one episode proved fatal, the other 17 recovered rapidly, with a mean ICU stay lasting 4.6 (2-15) days. Typically, the evolution was rapidly favorable under supportive care. CONCLUSION NPPE-related DAH is a rare life-threatening condition occurring primarily after tonic-clonic generalized seizure or generalized anesthesia. Clinical circumstances are a key to its diagnosis. Early diagnosis and recognition likely allow for successful management of this potentially serious complication, whereas ictal-DAH appears ominous in epileptic patients.
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Affiliation(s)
- Damien Contou
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. .,Réanimation Polyvalente, Hôpital Victor Dupouy, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France.
| | - Guillaume Voiriot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Michel Djibré
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Vincent Labbé
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Antoine Parrot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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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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Kaya Z, Tuncez A, Gök U, Gül EE, Altunbaş G. Negative pressure pulmonary edema following septoplasty surgery triggering acute subendocardial myocardial infarction. Heart Views 2014; 15:46-8. [PMID: 25104982 PMCID: PMC4124665 DOI: 10.4103/1995-705x.137495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) is defined as fluid transudation into the pulmonary interstitium which occurs as a result of elevated negative intrathoracic pressure caused by the upper respiratory tract obstruction and strong inspiratory effort. NPPE is usually seen during emergence from general anesthesia in the early post-operative period especially after upper respiratory tract surgery. We present a case of a 37-year-old male patient who underwent septoplasty operation and developed NPPE which could not diagnosed and progressed to acute subendocardial myocardial infarction.
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Affiliation(s)
- Zeynettin Kaya
- Department of Cardiology, Konya Numune State Hospital, Konya, Turkey
| | - Abdullah Tuncez
- Department of Cardiology, Konya Numune State Hospital, Konya, Turkey
| | - Umut Gök
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Enes Elvin Gül
- Department of Cardiology, Malkara State Hospital, Tekirdağ, Turkey
| | - Gökhan Altunbaş
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey
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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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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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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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Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67:318-40. [PMID: 22321104 DOI: 10.1111/j.1365-2044.2012.07075.x] [Citation(s) in RCA: 297] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri-operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post-extubation care.
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Khallouki M, Arib S, Samkaoui MA. [Postobstructive pulmonary edema]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:63-64. [PMID: 22244467 DOI: 10.1016/j.pneumo.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/07/2011] [Indexed: 05/31/2023]
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Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth 2011; 5:308-13. [PMID: 21957413 PMCID: PMC3168351 DOI: 10.4103/1658-354x.84108] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a dangerous and potentially fatal condition with a multifactorial pathogenesis. Frequently, NPPE is a manifestation of upper airway obstruction, the large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. This negative pressure leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. The early detection of the signs of this syndrome is vital to the treatment and to patient outcome. The purpose of this review is to highlight the available literature on NPPE, while probing the pathophysiological mechanisms relevant in both the development of this condition and that involved in its resolution.
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Affiliation(s)
- Balu Bhaskar
- Critical Care Research Group, John B McCarthy Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia
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Abstract
PURPOSE OF REVIEW This article reviews current concepts in perioperative pulmonary management. RECENT FINDINGS Preoperative risk assessment tools for perioperative pulmonary complications (POPCs) are evolving for both children and adults. Intraoperative management strategies have a demonstrable effect on outcomes. Late POPCs may be preceded by clinical signs. SUMMARY POPCs are common and lead to significant resource utilization. Optimal POPC risk mitigation must span all phases of surgical care. Preoperative assessment may identify patients at risk and effectively lower their risk by identifying targeted interventions. Intra-operative strategies impact postoperative outcome. POPCs continue to be a concern for several days postoperatively. We review the current literature on this broad subject with a focus on implementable interventions for the clinician.
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Affiliation(s)
- Mukul C Kapoor
- Department of Anaesthesiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India. E-mail:
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Abstract
Non-invasive positive pressure ventilation or non-invasive ventilation (NIV) has emerged as a simpler and safer alternative to invasive mechanical ventilation in patients developing acute postoperative respiratory failure. The benefits of NIV as compared to intubation and mechanical ventilation include lower complications, shorter duration of hospital stay, reduced morbidity, lesser cost of treatment and even reduced mortality rates. However, its use may not be uniformly applicable in all patient groups. This article reviews the indications, contraindications and evidence supporting the use of NIV in individual patient groups in the postoperative period. The anaesthesiologist needs to recognise the subset of patients most likely to benefit from NIV therapy so as to apply it most effectively. It is equally important to promptly identify signs of failure of NIV therapy and be prepared to initiate alternate ways of respiratory support. The author searched PubMed and Ovid MEDLINE, without date restrictions. Search terms included Non-invasive ventilation, postoperative and respiratory failure. Foreign literature was included, though only articles with English translation were used.
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Affiliation(s)
- Ashu S Mathai
- Department of Anaesthesiology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Chen IC, Chen KH, Tseng CM, Hsu JH, Wu JR, Dai ZK. Croup-induced Postobstructive Pulmonary Edema. Kaohsiung J Med Sci 2010; 26:567-70. [DOI: 10.1016/s1607-551x(10)70088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022] Open
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Udeshi A, Cantie SM, Pierre E. Postobstructive pulmonary edema. J Crit Care 2010; 25:508.e1-5. [PMID: 20413250 DOI: 10.1016/j.jcrc.2009.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 12/14/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
Abstract
Postobstructive pulmonary edema (POPE; also known as negative pressure pulmonary edema) is a potentially life-threatening complication in which pulmonary edema occurs shortly after the relief of an upper airway obstruction. The incidence of POPE has been reported to be as high as 1 in 1000 general anesthetic cases and commonly presents as acute respiratory distress that requires immediate intervention. This review examines the 2 subclasses of POPE and describes the etiologic factors, pathophysiology, clinical manifestations, diagnostic criteria, and treatment strategies associated with each. The aim of this review was to equip clinicians with the knowledge base necessary to identify patients at increased risk for POPE and to expeditiously diagnose and treat this potentially catastrophic complication.
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Affiliation(s)
- Ashish Udeshi
- Department of Anesthesiology and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, Fla 33136, USA
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Domnica PJ, Floret D, Bouchut JC. Negative pressure pulmonary edema and airway foreign body retrieval: anesthetic considerations. Paediatr Anaesth 2010; 20:288-9. [PMID: 20470328 DOI: 10.1111/j.1460-9592.2009.03229.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Casoni GL, Tomassetti S, Coffa A, Ravaglia C, Poletti V, Pol V. Negative pressure pulmonary hemorrhage induced by a candy. Am J Emerg Med 2010; 28:112.e3-5. [PMID: 20006220 DOI: 10.1016/j.ajem.2009.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 02/15/2009] [Indexed: 12/14/2022] Open
Affiliation(s)
- Gian Luca Casoni
- Dipartimento Toracico, Ospedale GB Morgagni, 47100 Forlì, Italy.
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Perioperative management of patients who have pulmonary disease. Oral Maxillofac Surg Clin North Am 2009; 18:81-94, vi. [PMID: 18088813 DOI: 10.1016/j.coms.2005.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The identification of risk factors and optimization of respiratory status are crucial to the successful management of patients who have pulmonary disease and are undergoing a surgical procedure. This article explores the approach to pulmonary patients, from the preoperative assessment to the intraoperative and postoperative periods. The management of specific pulmonary disorders in the perioperative period is discussed.
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Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema. J Anesth 2009; 23:417-20. [PMID: 19685125 DOI: 10.1007/s00540-009-0757-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/26/2009] [Indexed: 12/19/2022]
Abstract
Negative-pressure pulmonary edema is a well-known complication of an acute upper airway obstruction, which may rarely present as acute alveolar hemorrhage in cases of severe capillary stress failure. Hemorrhage from the central airways has also been reported as a rare manifestation of acute tracheobronchial injury, associated with severe disruption of the bronchial vasculature due to highly negative inspiratory pressure. In this clinical report, we describe a case of both acute tracheobronchial and alveolar hemorrhage in a young man, occurring immediately after extubation due to laryngospasm, diagnosed by bronchoscopy with bronchoalveolar lavage (BAL), measurement of the pulmonary edema fluid/plasma protein ratio, and by thoracic computed tomography (CT) scan. We propose that the patient experienced severe postobstructive negative-pressure pulmonary edema, related to increased permeability of the alveolar capillary membrane and a parallel loss of integrity of the bronchial vascular network. Our findings suggest that both changes in the bronchial circulation and mechanical stress failure of the more distal alveolar-capillary system may be induced by severe and acute upper-airway obstruction.
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Isaacson G. Avoiding airway obstruction after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2009; 73:803-6. [PMID: 19286268 DOI: 10.1016/j.ijporl.2009.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 02/09/2009] [Accepted: 02/12/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a protocol designed to prevent post-adenotonsillectomy airway obstruction in small children with obstructive sleep apnea. DESIGN Computerized retrospective review of single surgeon case series. SETTING Tertiary children's medical center. METHODS Children with sleep study proven obstructive sleep apnea or children under the age of 3 years with clinically suspected obstructive sleep apnea were treated according to a protocol that included: (1) rapid bloodless tonsillectomy; (2) repeated release of the tonsillar retractor; (3) avoidance of uvular edema; (4) routine intra-operative intranasal oxymetazoline, and placement of nasal airway; (5) extended recovery room observation. Primary outcome measures were (1) avoidance of unexpected intensive care unit admission; (2) post-extubation pulmonary edema; (3) aspiration pneumonia. RESULTS During the period March 2004-August 2007, 864 children underwent adenotonsillectomy by a single surgeon-604 for the indication of obstructive sleep apnea or adenotonsillar hypertrophy with obstruction. Two hundred and ten were under the age of 3 years or had sleep study proven obstructive sleep apnea. There were two unexpected admissions to the pediatric intensive care unit for persistent upper airway obstruction-none required intubation. No child developed post-obstructive pulmonary edema. Three children were treated for infiltrates consistent with aspiration pneumonitis. CONCLUSION Most cases of post-extubation pulmonary edema and pneumonia can be avoided in young children and those with mild-to-moderate obstructive sleep apnea following a protocol that anticipates and avoids precipitating causes of upper airway obstruction.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology - Head & Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Abstract
Obstructive sleep apnea (OSA) is common and increasingly so in countries experiencing an epidemic of obesity. The rate of OSA is likely as high or higher in psychiatric patients and patients receiving electroconvulsive therapy (ECT) as compared with the general population. Obstructive sleep apnea can be detected by maintaining a high degree of suspicion in patients with risk factors, symptoms, and typical physical findings. Failure to detect OSA can lead to serious long-term problems with cardiovascular health, excessive sleepiness, and increased risk of motor vehicle accidents. It is unknown whether failure to treat OSA could promote failure to respond to ECT or greater cognitive problems with ECT, but failure to recognize and manage the risk for OSA in patients receiving ECT might expose them to anesthetic difficulties. Ideally, patients with suspected OSA should have a sleep laboratory evaluation and a definitive treatment plan in place before ECT, but, sometimes, psychiatric urgency and lack of access to resources in developing countries would make this unworkable. At a minimum, steps can be taken during the ECT procedure to manage airway obstruction in suspected or known patients with OSA.
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Sinha A, Sivanandan S, Ramesh P, Lodha R, Kabra SK. Post obstructive pulmonary edema in a child who attempted suicidal hanging. Indian J Pediatr 2008; 75:1075-7. [PMID: 18568437 DOI: 10.1007/s12098-008-0091-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 02/28/2008] [Indexed: 11/29/2022]
Abstract
Postobstructive pulmonary edema occurs rarely in children. We describe here a child who attempted suicide by hanging and developed postobstructive pulmonary edema and was successfully managed. There was a rapid response to management with morphine and supportive care, enabling extubation by 30 hours of ventilatory support. The case highlights an unusual cause of postobstructive pulmonary edema.
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Affiliation(s)
- Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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47
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Hutchings S, Ahmed T. An Unusual Cause of Breathlessness. J Intensive Care Soc 2007. [DOI: 10.1177/175114370700800311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Tim Ahmed
- SHO in ENT Southampton General Hospital
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Fiorello CV, Cunningham MW, Cantwell SL, Levy JK, Neer EM, Conley K, Rist PM. Diagnosis and treatment of presumptive postobstructive pulmonary edema in a Florida panther (Puma concolor coryi). J Zoo Wildl Med 2007; 38:317-22. [PMID: 17679517 DOI: 10.1638/1042-7260(2007)038[0317:datopp]2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A free-ranging, adult male Florida panther (Puma concolor coryi) was immobilized and evaluated for hematuria following routine capture. Prior to anesthetic recovery, the panther was fitted with a telemetry collar. After an initially quiet recovery, the panther began thrashing in the transport cage, and was again immobilized. Pink foam was evident from the nostrils, and crackles were ausculted over the chest, indicating pulmonary edema. Postobstructive pulmonary edema was diagnosed based on history, clinical signs, radiographic evaluation, and blood gas analysis. The animal was treated intensively for several hours with diuretics, oxygen, and manual ventilation. The panther responded rapidly to therapy and was released back into the wild 48 hr after presentation. Postobstructive pulmonary edema, also called negative-pressure pulmonary edema, may be underrecognized in veterinary medicine. In this case, the telemetry collar, in conjunction with anesthetic recovery in a small transport crate, may have contributed to tracheal obstruction. Wildlife veterinarians and biologists should be aware of the risk of airway obstruction when placing tracking collars, and animals should be continuously monitored during anesthetic recovery to ensure the presence of a patent airway.
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Affiliation(s)
- Christine V Fiorello
- Department of Small Animal Clinical Scienc es, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32610, USA.
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49
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Walker RWM, Sutton RS. Which port in a storm? Use of suxamethonium without intravenous access for severe laryngospasm. Anaesthesia 2007; 62:757-9. [PMID: 17635421 DOI: 10.1111/j.1365-2044.2007.05226.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Chapman MJ, Myburgh JA, Kluger MT, Runciman WB. Crisis management during anaesthesia: pulmonary oedema. Qual Saf Health Care 2007; 14:e8. [PMID: 15933305 PMCID: PMC1744004 DOI: 10.1136/qshc.2002.004267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Diagnosis may be difficult during anaesthesia and consequently management may be delayed. OBJECTIVES To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for pulmonary oedema, in its management occurring in association with anaesthesia. METHODS The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS Pulmonary oedema was identified in 35 (<1%) of the first 4000 reports to AIMS. The most frequent presenting sign was hypoxia (46%) and the most specific sign was the presence of frothy sputum (23%). The core algorithm, although successful in the management of the initial physiological upset, was found to be inadequate for the ongoing management of pulmonary oedema. A specific sub-algorithm for the management of perioperative pulmonary oedema was devised, tested against the reports and would have been effective, if properly applied, in the management of all but one of the reported cases. CONCLUSION Successful recognition and management of perioperative pulmonary oedema is likely with the application of the structured algorithm and specific sub-algorithm approach outlined in this study.
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Affiliation(s)
- M J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, and University of Adelaide, Adelaide, South Australia, Australia
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