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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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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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Lee DH, Lee N. Negative pressure pulmonary edema after general anesthesia using the i-gel. Saudi J Anaesth 2024; 18:123-125. [PMID: 38313720 PMCID: PMC10833014 DOI: 10.4103/sja.sja_574_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 02/06/2024] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a rare complication that occurs mainly after tracheal extubation. We report a case of postoperative NPPE associated with the use of the i-gel. A 28-year-old woman was scheduled for an emergency right axillary sentinel lymph node excision. During emergence, the patient experienced a sudden onset of airway obstruction, and spontaneous ventilation through the i-gel was impossible. Pink and frothy secretions were noted in the i-gel and the patient's oral cavity. Positive airway pressure with 100% oxygen was applied using a facemask, and the patient was subsequently treated with high-flow oxygen therapy. In this case, laryngospasm or displacement of the i-gel was believed to be the cause of airway obstruction. We recognized that NPPE is likely to occur regardless of the airway device, and the use of the i-gel cannot completely eliminate the possibility of NPPE occurrence.
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Affiliation(s)
- Deok-hee Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Nawon Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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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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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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Matsumura K, Toyoda Y, Matsumoto S, Funabiki T. Near-fatal negative pressure pulmonary oedema successfully treated with venovenous extracorporeal membrane oxygenation performed in the hybrid emergency room. BMJ Case Rep 2020; 13:13/9/e234651. [PMID: 32912881 PMCID: PMC7482455 DOI: 10.1136/bcr-2020-234651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We report a rare case of negative pressure pulmonary oedema (NPPE), a life-threatening complication of tracheal intubation. A 41-year-old obese man was admitted to a previous hospital for neck surgery. After extubation, he developed respiratory distress followed by haemoptysis and desaturation. The patient was reintubated and brought to our hospital where we introduced venovenous extracorporeal membrane oxygenation (ECMO) to prevent cardiac arrest, which is an unusual clinical course for NPPE. He returned to his routine without any sequelae. This is the first case report of NPPE successfully resolved with venovenous ECMO in the hybrid emergency room (hybrid ER), which is a resuscitation room equipped with interventional radiology features and a sliding CT scanner. Since the hybrid ER serves as a single move for patients where all necessary procedures are performed, it has the potential to lower the incidence of cannulation complications, beyond the delay in ECMO initiation.
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Affiliation(s)
- Kazuki Matsumura
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yukitoshi Toyoda
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shokei Matsumoto
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Tomohiro Funabiki
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
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