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Chaverra Kornerup S, Parotto M. Extubation-Related Complications. Int Anesthesiol Clin 2024; 62:82-90. [PMID: 39233574 DOI: 10.1097/aia.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Extubation represents an essential component of airway management. While being a common procedure in anesthesiology and critical care medicine, it is accompanied by a significant risk of morbidity and mortality. Safe extubation requires considerable skills, risk stratification and advanced planning. It is important to emphasize that intentional extubation is always an elective procedure, and as such should only be executed when conditions are optimal. The purpose of this review is to discuss the complications associated with planned extubation in the adult patient, including risk factors and management strategies, mainly focusing on the postoperative setting.
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Affiliation(s)
- Santiago Chaverra Kornerup
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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2
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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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3
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Ma J, Liu T, Wang Q, Xia X, Guo Z, Feng Q, Zhou Y, Yuan H. Negative pressure pulmonary edema (Review). Exp Ther Med 2023; 26:455. [PMID: 37614417 PMCID: PMC10443067 DOI: 10.3892/etm.2023.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/25/2023] [Indexed: 08/25/2023] Open
Abstract
Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.
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Affiliation(s)
- Jin Ma
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Tiantian Liu
- Department of Rehabilitation, Shanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, P.R. China
| | - Qiang Wang
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Xiaohua Xia
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Zhiqiang Guo
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Qiupeng Feng
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Yan Zhou
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
| | - Hua Yuan
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, P.R. China
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4
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Muacevic A, Adler JR, Woltmann G. Neurogenic Pulmonary Edema Presenting as a Pulmonary Entity. Cureus 2022; 14:e32002. [PMID: 36589194 PMCID: PMC9798242 DOI: 10.7759/cureus.32002] [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: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Acute dyspnea is one of the most common presentations in acute/emergency settings, and acute pulmonary edema remains a leading cause in adults resulting from either cardiogenic or non-cardiogenic etiologies. Neurogenic pulmonary edema (NPE) is one of the less common forms of non-cardiogenic pulmonary edema seen in emergency departments, neurology units, or intensive care units. It usually develops rapidly following significant neurological insult seen in patients with intracranial hemorrhage, traumatic brain injuries, and epileptic seizures. It is less commonly seen after a multitude of other sudden catastrophic neurologic insults. Here, we report a case study of a 32-year-old female with a history of epilepsy since childhood who was admitted to our respiratory admission unit on two separate occasions with acute NPE and type I respiratory failure after a witnessed tonic-clonic seizure episode. Although the clinical features of NPE and the results of investigations can mimic more common cardiorespiratory conditions, an accurate and timely diagnosis is vital for the appropriate emergency management and to improve the patient's outcome.
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5
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Cheng JZ, Wang J. Negative Pressure Pulmonary Edema Related to Laryngospasm and Upper Airway Obstruction in a Patient With Treacher Collins Syndrome. Cureus 2021; 13:e14426. [PMID: 34079650 PMCID: PMC8159308 DOI: 10.7759/cureus.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.
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Affiliation(s)
- Jenny Zhao Cheng
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
| | - Jingping Wang
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
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6
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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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7
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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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8
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Grant BM, Ferguson DH, Aziz JE, Aziz SM. Successful use of VV ECMO in managing negative pressure pulmonary edema. J Card Surg 2020; 35:930-933. [PMID: 32069370 DOI: 10.1111/jocs.14472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The indications for extracorporeal membrane oxygenation (ECMO) are expanding. Postobstructive pulmonary edema, also known as negative pressure pulmonary edema, can result in severe respiratory compromise and acute respiratory distress syndrome. We present a case of a 26-year-old female with laryngeal papillomatosis and laryngospasm after direct laryngoscopy, who developed severe NPPE refractory to mechanical ventilator support, which was successfully treated with veno-venous ECMO.
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Affiliation(s)
- Brian M Grant
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Deangelo H Ferguson
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Jenna E Aziz
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
| | - Salim M Aziz
- Department of Surgery, Howard University Hospital, Washington, District of Columbia
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9
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Neurogenic Pulmonary Edema Following a Seizure: A Case Report and Literature Review. Case Rep Neurol Med 2019; 2019:6867042. [PMID: 31687236 PMCID: PMC6803739 DOI: 10.1155/2019/6867042] [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: 04/05/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Acute pulmonary edema is one of the frequent causes of dyspnea encountered in everyday practice. It is broadly attributed to be either cardiogenic or noncardiogenic. It is usually treated with diuretics in addition to other medications depending on the underlying pathology. Here, we report a case of a female patient who presented with shortness of breath after developing a seizure. Further investigations excluded cardiogenic etiology and showed critically low phenytoin level. It improved within 48 h of supportive care without giving diuretics favoring the diagnosis of neurogenic pulmonary edema as the primary pathology. The goal of our case report is to keep neurogenic pulmonary edema in mind, and hence provide the appropriate management, when dealing with similar cases.
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10
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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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11
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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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12
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Chen G, Wang XD, Nie HF, Yang ZQ, Chen K, Li ZH, Song YM, Pei FX, Zeng JC. Negative pressure pulmonary edema after percutaneous endoscopic interlaminar lumbar discectomy-a case report. BMC Musculoskelet Disord 2018; 19:401. [PMID: 30428864 PMCID: PMC6236950 DOI: 10.1186/s12891-018-2306-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/17/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Negative pressure pulmonary edema (NPPE) is a rare complication that is more prevalent in young patients. NPPE usually results from acute upper airway obstruction, which is most commonly caused by laryngospasm during extubation. NPPE is characterized by the sudden onset of coughing, hemoptysis, tachycardia, tachypnea, and hypoxia, and is dramatically improved with supportive care, which prevents severe sequelae. To our knowledge, there is no report of a patient developing NPPE after percutaneous endoscopic interlaminar lumbar discectomy. CASE PRESENTATION Herein, we report the case of a 22-year-old amateur basketball player with L5/S1 disc herniation who developed NPPE during extubation after general anesthesia for a minimally invasive spinal surgery (percutaneous endoscopic interlaminar lumbar discectomy). The NPPE was treated by maintaining the airway patency, applying positive-pressure ventilation, administering dexamethasone and antibiotics, and limiting the volume of fluid infused. The patient had an uneventful postoperative course, and was discharged to his home on postoperative day 3. CONCLUSIONS Although NPPE is an infrequent complication, especially in patients undergoing percutaneous endoscopic interlaminar lumbar discectomy, this case report highlights the importance of early diagnosis and prompt treatment of NPPE to prevent the development of potentially fatal complications.
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Affiliation(s)
- Guo Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
- Department of Orthopaedic Surgery, the Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Road, Nanchong, Sichuan Province 637000 China
| | - Xian-di Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Hong-fei Nie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Zhi-qiang Yang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Kang Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Zhu-hai Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Yue-ming Song
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Fu-xing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
| | - Jian-cheng Zeng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, N0.37 Guoxue Road, Chengdu, Sichuan Province 610041 China
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13
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Vega JL. Ictal Mammalian Dive Response: A Likely Cause of Sudden Unexpected Death in Epilepsy. Front Neurol 2018; 9:677. [PMID: 30174646 PMCID: PMC6108060 DOI: 10.3389/fneur.2018.00677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/27/2018] [Indexed: 12/22/2022] Open
Abstract
Even though sudden unexpected death in epilepsy (SUDEP) takes the lives of thousands of otherwise healthy epilepsy patients every year, the physiopathology associated with this condition remains unexplained. This article explores important parallels, which exist between the clinical observations and pathological responses associated with SUDEP, and the pathological responses that can develop when a set of autonomic reflexes known as the mammalian dive response (MDR) is deployed. Mostly unknown to physicians, this evolutionarily conserved physiological response to prolonged apnea economizes oxygen for preferential use by the brain. However, the drastic cardiovascular adjustments required for its execution, which include severe bradycardia and the sequestration of a significant portion of the total blood volume inside the cardiopulmonary vasculature, can result in many of the same pathological responses associated with SUDEP. Thus, this article advances the hypothesis that prolonged apneic generalized tonic clonic seizures induce augmented forms of the MDR, which, in the most severe cases, cause SUDEP.
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Affiliation(s)
- Jose L Vega
- Department of Neurosciences and Stroke, Novant Health, Forsyth Medical Center, Winston-Salem, NC, United States.,TeleNeurologia SAS, Medellin, Colombia
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14
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Suffocation From Balloon Bronchoplasty. J Bronchology Interv Pulmonol 2018; 25:156-160. [PMID: 29561395 DOI: 10.1097/lbr.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Negative pressure pulmonary edema is a well-described complication of upper airway obstruction. However, the simultaneous occurrence of blood-stained secretions and petechial tracheobronchial hemorrhage are rarely recognized and a potential complication of transient intentional occlusion of the airways. We described a case of "hemorrhagic bronchial mucosa syndrome" and asymptomatic blood-tinged pulmonary edema after balloon bronchoplasty for a concentric tracheal stenosis using a flexible bronchoscopy. This was characterized by interval appearance of diffuse petechial tracheobronchial bleeding and a persistent blood-tinged alveolar effluent after sustained occlusion of the airway. The simultaneous occurrence of both phenomena in this patient suggests different degrees of injury in a common pathogenic spectrum. We postulate that sustained, complete occlusion of the airway produces variable degrees of mechanical disruption of the bronchial and alveolar vasculature that lead to the development of negative pressure pulmonary edema and tracheobronchial hemorrhage. In this case, the syndrome was self-limited and without major consequences but highlights an unrecognized potential complication of balloon bronchoplasty.
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15
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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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Bouhabba N, Bensghir M, Fjouji S, Azendour H, Haimeur C. [Acute post surgical lung edema: a severe complication]. Pan Afr Med J 2015; 20:229. [PMID: 26140072 PMCID: PMC4482528 DOI: 10.11604/pamj.2015.20.229.5840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/05/2015] [Indexed: 11/16/2022] Open
Abstract
L’œdème aigu pulmonaire (OAP) post-obstructif est une complication respiratoire grave qui doit être reconnue par les anesthésistes et les réanimateurs a fin de permettre une prise en charge diagnostique et thérapeutique précoce. Nous rapportons un cas survenu chez un jeune patient en postopératoire d'une appendicectomie. Immédiatement après l'extubation le patient a développé une détresse respiratoire, une désaturation et des signes auscultatoires et radiologiques évoquant un œdème aigu du poumon. Un bilan étiologique, notamment cardiaque, est revenu normal et l’évolution était favorable dans les heures qui suivent après reintubation et traitement par diurétiques. Le diagnostic de l'OAP post-obstructif était alors retenu. A travers ce cas et une revue de la littérature, les auteurs mettent en relief cette complication redoutable nécessitant une prise en charge précoce.
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Affiliation(s)
- Najib Bouhabba
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Mustapha Bensghir
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Salaheddine Fjouji
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Hicham Azendour
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
| | - Charki Haimeur
- Département d'Anesthésie Réanimation, Hôpital Militaire d'Instructions Mohamed V, Rabat, Maroc
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17
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Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration. Seizure 2015; 27:19-24. [PMID: 25844030 DOI: 10.1016/j.seizure.2015.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. METHODS Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. RESULTS Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p=0.002) in GTCS with abnormal CXR (259.7 sec) versus GTCS with normal CXR (101.2 sec). Odds-ratio for CXR abnormality was 20.46 (p=0.006) with seizure duration greater than 100 sec versus less than 100 sec. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p=0.015). CONCLUSIONS Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.
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18
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García de Hombre AM, Cuffini A, Bonadeo A. Negative Pressure Pulmonary Oedema After Septoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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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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20
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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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21
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Kumar D, O'Hare B, Timon C, Mukhtar M, Kelly D. Bilateral pneumothoraces and pulmonary oedema following tracheostomy induced by acute tracheal obstruction. BMJ Case Rep 2012; 2012:bcr-2012-006557. [PMID: 22879001 DOI: 10.1136/bcr-2012-006557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the presentation of bilateral pneumothoraces with pulmonary oedema following an elective tracheostomy. A 69-year-old man underwent panendoscopy following primary chemoradiotherapy for locally invasive vocal cord carcinoma. A tracheostomy was performed for upper airway oedema and necrosis. Postoperatively, acute airway obstruction with profound desaturation developed. Tracheostomy tube suctioning dislodged an airway clot with clinical improvement and restoration of bilateral breath sounds. A chest X-ray subsequently demonstrated bilateral pneumothoraces with marked pulmonary oedema. Management, including chest drain insertion, resulted in stabilisation and subsequent full recovery. This case highlights the potential for more than one cause of life-threatening complication following tracheostomy. The importance of considering multiple pathologies in the setting of severe hypoxia and to institute prompt management is emphasised.
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Affiliation(s)
- Deepak Kumar
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland.
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22
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García de Hombre AM, Cuffini A, Bonadeo A. Negative pressure pulmonary oedema after septoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:300-2. [PMID: 22465189 DOI: 10.1016/j.otorri.2012.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 12/28/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
Abstract
Negative pressure pulmonary oedema (NPPO) is an anaesthetic complication due to acute obstruction of the upper airway, whose main cause is laryngospasm. The pathophysiology involves a strong negative intrapleural pressure during inspiration against a closed glottis, which triggers excessive pressure in the pulmonary microvasculature. Although its diagnosis can be difficult, its recognition helps to minimise morbidity and mortality. This article presents a case of NPPO due to postextubation laryngospasm.
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Affiliation(s)
- Alina M García de Hombre
- Servicio de Otorrinolaringología, Hospital General de Fuerteventura, Puerto del Rosario, Las Palmas, España.
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23
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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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24
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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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25
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Abstract
An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds. Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence. Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.
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Affiliation(s)
- Vikas Pathak
- Department of General Internal Medicine, Marshfield Clinic, WI 54449, USA.
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26
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Malepati S, Samant S, Sietsema KE, Van Natta TL. A 26-year-old man with postextubation dyspnea and hemoptysis. Chest 2011; 139:708-711. [PMID: 21362660 DOI: 10.1378/chest.10-2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sarath Malepati
- Division of Cardiothoracic Surgery, Harbor-UCLA Medical Center, Torrance, CA.
| | - Shefali Samant
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Kathy E Sietsema
- Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Timothy L Van Natta
- Division of Cardiothoracic Surgery, Harbor-UCLA Medical Center, Torrance, CA
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27
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Saha A, Bansal A, Kaur S. Post obstructive pulmonary edema following accidental strangulation. Indian J Pediatr 2010; 77:584. [PMID: 20140774 DOI: 10.1007/s12098-010-0016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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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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29
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Mamiya H, Ichinohe T, Kaneko Y. Negative pressure pulmonary edema after oral and maxillofacial surgery. Anesth Prog 2009; 56:49-52. [PMID: 19642719 DOI: 10.2344/0003-3006-56.2.49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 02/18/2009] [Indexed: 11/11/2022] Open
Abstract
Negative pressure pulmonary edema (NPPE) following upper airway obstruction (UAO) has been reported in several clinical situations. The main cause of NPPE is reported to be increased negative intrathoracic pressure. We present a case of NPPE that occurred after general anesthesia for plate removal after jaw deformity surgery. After completion of the surgery, administration of inhaled anesthetics was stopped and the patient opened his eyes on verbal command. Immediately after extubation, the patient stopped breathing and became cyanotic. Acute UAO following laryngospasm was suspected. Soon after reintubation, pink, frothy fluid came out of the endotracheal tube, and a tentative diagnosis of NPPE was made. Continuous positive airway pressure was applied. In addition, furosemide and dexamethasone were administered. By the next day, the symptoms had almost disappeared.
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Affiliation(s)
- Hideki Mamiya
- Department of Dental Anesthesiology, Tokyo Dental College, Chiba, Japan.
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30
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de Lurdes Castro M, Chaves P, Canas M, Moedas ML. Edema agudo do pulmão pós-extubação traqueal – Caso clínico. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009. [DOI: 10.1016/s0873-2159(15)30152-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
UNLABELLED Sudden severe upper-airway obstruction occurring in a hospital setting can sometimes precipitate an episode of acute haemorrhagic pulmonary oedema. A review of 197 published case reports shows that the presenting feature is almost always the sudden appearance of blood stained fluid coming up through the larynx or out through the mouth and nose of an adult or child in obvious respiratory distress. Such overt features are seen in 10-15% of cases of sudden severe, but sub-lethal, upper-airway obstruction. Signs normally appear within minutes once the obstruction is relieved but are occasionally only recognized after 1-4 h. All signs and symptoms usually resolve within 12-24 h. Other causes of acute pulmonary haemorrhage are rare in young children. CONCLUSION If what looks like blood is seen in, or coming from, the mouth or nose of a previously healthy young child who has suddenly become distressed and started to struggle for breath, that child has most probably suffered an episode of acute pulmonary oedema, and the commonest precipitating cause is sudden upper-airway obstruction.
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32
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Mulkey Z, Yarbrough S, Guerra D, Roongsritong C, Nugent K, Phy MP. Postextubation pulmonary edema: a case series and review. Respir Med 2008; 102:1659-62. [PMID: 18804361 DOI: 10.1016/j.rmed.2008.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/01/2008] [Indexed: 11/28/2022]
Abstract
UNLABELLED We report a series of patients with postextubation pulmonary edema who had no obvious risk factors for the development of this syndrome. METHODS Patients identified by the pulmonary consultation service at an academic medical center were reviewed. RESULTS Fourteen cases were collected and analyzed. The average age was 34.5 years; 12 patients were male. The average BMI was 25.5. None had documented previous lung disease. Most operations were scheduled as outpatient procedures, and the type of surgery ranged from an incision and drainage of a bite wound to an open reduction-internal fixation of the radius. None of the patients had upper airway surgery. The length of surgeries ranged from 27 to 335 min. Laryngospasm was the most commonly identified obstructing event postextubation. Treatment involved airway support when needed, supplemental oxygen, and diuretics. CONCLUSIONS It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains uncertain in many cases.
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Affiliation(s)
- Z Mulkey
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 3601 4th Street, Lubbock, TX 79430, United States
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33
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Paratz JD, Thomas PJ. A case of near fatal laryngospasm. THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2008; 54:291-292. [PMID: 19025517 DOI: 10.1016/s0004-9514(08)70019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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34
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Suh JK, Yeom JH, Bae DJ. Negative-pressure Pulmonary Edema by Doxapram-induced Larygospasm - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.2.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jung Kook Suh
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Jong-Hoon Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
| | - Dong-Jun Bae
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, Seoul, Korea
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35
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Idabouk L, Minville V, Salau S, Castel A, Franchitto N, Pourrut JC. Œdème pulmonaire après une arthroscopie du genou. ACTA ACUST UNITED AC 2006; 25:1007-10. [PMID: 16891092 DOI: 10.1016/j.annfar.2006.03.043] [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] [Received: 08/24/2005] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
Negative pressure pulmonary oedema is one form of non cardiogenic pulmonary oedema that can occur following any general anaesthesia in which the patient was intubated. This complication can be severe, resulting in death/life-threatening if not diagnosed and treated promptly. We report a case of negative pressure pulmonary oedema, in a 26-year-old man, secondary to inspiratory effort with laryngeal spasm. Patient was transferred to intensive care unit for monitoring and non invasive ventilation. Prevention, early diagnosis, and prompt treatment allowed a rapid and uncomplicated resolution.
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Affiliation(s)
- L Idabouk
- Département d'anesthésie et de réanimation, CHU de Toulouse, université Paul-Sabatier, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 09, France
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36
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Ikeda H, Asato R, Chin K, Kojima T, Tanaka S, Omori KI, Hiratsuka Y, Ito J. Negative-pressure pulmonary edema after resection of mediastinum thyroid goiter. Acta Otolaryngol 2006; 126:886-8. [PMID: 16846936 DOI: 10.1080/00016480500527235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Negative-pressure pulmonary edema (NPPE) is an uncommon but life-threatening complication of acute or chronic upper airway obstruction; however, there are few reports of NPPE after giant goiter resection. We report a case with severe NPPE induced by the resection of a mediastinum thyroid goiter. The patient was successfully treated by non-invasive positive airway ventilation (NPPV).
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Affiliation(s)
- Haruto Ikeda
- Kyoto University Hospital, Kyoto University, Kyoto, Japan
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37
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Westreich R, Sampson I, Shaari CM, Lawson W. Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention. ACTA ACUST UNITED AC 2006; 8:8-15. [PMID: 16415442 DOI: 10.1001/archfaci.8.1.8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To provide rhinologic surgeons with an understanding of acute negative-pressure pulmonary edema (NPPE) and its treatment. DESIGN Case report and literature review of all published adult cases of NPPE. Patient factors, anesthetic variables, and outcomes are assessed. RESULTS A total of 146 cases in 45 case reports and series were compiled. There was approximately a 2:1 male-female patient ratio. The average age of the patients was 33 years. Fifty percent of patients had surgery on the upper aerodigestive tract, and 8% had intranasal surgery. No patients received laryngotracheal anesthesia, and 5 of the 146 received intravenous lidocaine prior to extubation. One patient had NPPE following laryngeal mask airway treatment, and 2 patients experienced this complication after conversion from monitored anesthesia care to general endotracheal anesthesia; 33.5% of patients were treated with continuous positive airway pressure alone, while 66.5% required intubation and mechanical ventilation. The average time to resolution was 11.75 hours. Three patients died. CONCLUSIONS It is known that surgical procedures involving the upper aerodigestive tract have a higher risk of NPPE than other procedures. Rapid diagnosis and treatment is necessary to achieve early resolution and avoid significant patient morbidity. A thorough understanding is integral to the practice of nasal and paranasal sinus surgery, especially with the rising use of outpatient and office-based surgical suites. Therefore, we present a review of pathophysiologic mechanisms, possible risk factors, treatment options, and potential steps that can be taken to minimize this potentially devastating complication of general anesthesia.
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Affiliation(s)
- Richard Westreich
- Department of Otolarynogology, Mount Sinai Hospital, New York, NY 10029, USA.
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Silva PSLD, Monteiro Neto H, Andrade MMT, Neves CVDM. Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children. Pediatr Emerg Care 2005; 21:751-4. [PMID: 16280950 DOI: 10.1097/01.pec.0000186430.92388.a6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
UNLABELLED Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition. CASE A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. Pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Department of Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Universidade Federal de São Paulo, São Paulo, Brazil.
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Ackland GL, Mythen MG. Negative pressure pulmonary edema as an unsuspected imitator of acute lung injury/ARDS. Chest 2005; 127:1867-8. [PMID: 15888877 DOI: 10.1378/chest.127.5.1867-a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Perez RO, Bresciani C, Jacob CE, Perez CG, Coser RB, Honda LFK, Gama-Rodrigues JJ. Negative pressure post-extubation pulmonary edema complicating appendectomy in a young patient: Case report. ACTA ACUST UNITED AC 2004; 61:463-5. [PMID: 15475096 DOI: 10.1016/j.cursur.2004.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Negative-pressure pulmonary edema after endotracheal intubation is an uncommon and potentially serious complication of patients undergoing general anesthesia for different surgical procedures. We report a case of a healthy 20-year-old male patient with the diagnosis of acute appendicitis. The patient was submitted to appendectomy under general anesthesia and developed negative-pressure pulmonary edema immediately after extubation. The present paper reports this potentially serious complication illustrating the main radiological findings consistent with alveolar hemorrhage in this setting and the treatment performed.
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Affiliation(s)
- Rodrigo O Perez
- Colorectal Surgery Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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41
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Abstract
Children with either acute or chronic upper airway obstruction are at risk for postobstructive pulmonary edema. Appropriate diagnosis and management are important in leading to a good outcome for the patient. We describe 2 cases of postobstructive pulmonary edema caused by brief acute upper airway obstruction. In the first case, a child choked on a hot dog and in the second on a "jawbreaker." Both children developed symptoms of complete upper airway obstruction and were managed initially with the Heimlich maneuver and subsequently developed increased work of breathing associated with an oxygen requirement after relief of the obstruction. Both children were managed in the pediatric intensive care unit and were discharged after resolution of symptoms without sequelae.
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Affiliation(s)
- Sarah Ringold
- University of Washington School of Medicine Department of Pediatrics and Children's Hospital and Regional Medical Center, Seattle, WA, USA
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42
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Abstract
Negative pressure pulmonary edema (also known as postobstructive pulmonary edema) is one form of noncardiogenic pulmonary edema that can occur following any general anesthetic in which the patient was intubated. This complication can be severe, resulting in death if not diagnosed and treated promptly. This review explains the cause, incidence, symptomatology, and treatment of patients with this form of noncardiogenic pulmonary edema. A case study is also included to highlight how a patient may present with this complication in the PACU. This article is meant as a review and resource to nurses caring for postanesthesia patients in the PACU, ICU, or surgical floor because documented cases of negative pressure pulmonary edema have occurred as late as 6 hours postoperatively.
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Affiliation(s)
- Shauna Ely Tarrac
- Postanesthesia Care Unit, Sharp Memorial Hospital, San Diego, CA, USA.
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Yaqini K, Mjahed K, Khaleq K, Elkettani C, Barrou L. Œdème pulmonaire postopératoire secondaire à une paralysie récurrentielle bilatérale. ANNALES FRANÇAISES D'ANESTHÉSIE ET DE RÉANIMATION 2003; 22:914-5. [PMID: 14644378 DOI: 10.1016/j.annfar.2003.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koh MS, Hsu AAL, Eng P. Negative pressure pulmonary oedema in the medical intensive care unit. Intensive Care Med 2003; 29:1601-4. [PMID: 12879236 DOI: 10.1007/s00134-003-1896-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2002] [Accepted: 06/03/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Negative pressure pulmonary oedema (NPPE) occurring in the medical intensive care unit (MICU) is an uncommon, probably under-diagnosed, but life-threatening condition. DESIGN Retrospective data collection. SETTING Medical intensive care unit in a 1,500-bedded tertiary care hospital. PATIENTS AND PARTICIPANTS Five patients were diagnosed between January 1998 and January 2002. INTERVENTIONS None. MEASUREMENTS AND RESULTS Five patients were diagnosed to have NPPE from different aetiologies. These were acute epiglottitis, post-stenting of right bronchus intermedius stenosis, strangulation, compression from a goitre and one patient developed diffuse alveolar haemorrhage after biting the endotracheal tube during recovery from anaesthesia. All patients responded rapidly to supplemental oxygen, positive pressure ventilation and correction of underlying aetiologies. Pulmonary oedema resolved rapidly. CONCLUSIONS There is a large spectrum of aetiologies causing NPPE in the medical intensive care unit.
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Affiliation(s)
- Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, 169608 Singapore, Singapore.
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Walker RWM, Colovic V, Robinson DN, Dearlove OR. Postobstructive pulmonary oedema during anaesthesia in children with mucopolysaccharidoses. Paediatr Anaesth 2003; 13:441-7. [PMID: 12791120 DOI: 10.1046/j.1460-9592.2003.00969.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present case reports of five patients with severe forms of mucopolysaccharidoses who developed postobstructive pulmonary oedema during anaesthesia. The difficulties of anaesthesia in these patients and the particular predisposition that these patients exhibit for the development of postobstructive pulmonary oedema is discussed.
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Affiliation(s)
- R W M Walker
- Department of Anaesthetisia, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK
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46
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Ciavarro C, Kelly JPW. Postobstructive pulmonary edema in an obese child after an oral surgery procedure under general anesthesia: a case report. J Oral Maxillofac Surg 2002; 60:1503-5. [PMID: 12465019 DOI: 10.1053/joms.2002.36147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cesare Ciavarro
- Oral and Maxillofacial Surgery, Hospital of St Raphael, New Haven, CT 06511, USA
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Taha S, Bartelmaos T, Kassas C, Khatib M, Baraka A. Complicated negative pressure pulmonary oedema in a child with cerebral palsy. Paediatr Anaesth 2002; 12:181-6. [PMID: 11882233 DOI: 10.1046/j.1460-9592.2002.00814.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 3-year-old child with cerebral palsy developed postextubation upper airway obstruction secondary to laryngospasm and/or masseteric spasm,which may have been triggered by the muscular spasticity and the slow recovery from inhalational anaesthesia associated with cerebral palsy. This upper airway obstruction was followed by negative pressure pulmonary oedema. The patient improved on mechanical ventilation; however, his condition was complicated with the occurrence of bilateral pneumothoraces. After release of the pneumothoraces and reexpansion of the lungs, the child developed reexpansion pulmonary oedema, culminating in acute lung injury.
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Affiliation(s)
- Samar Taha
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
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García Sanz M, García Sánchez E, Jiménez Moya A, Bustinza Arriortúa A, López-Herce Cid J. Niño de 6 años con dificultad respiratoria postextubación. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sow Nam Y, Garewal D. Pulmonary hemorrhage in association with negative pressure edema in an intubated patient. Acta Anaesthesiol Scand 2001; 45:911-3. [PMID: 11472296 DOI: 10.1034/j.1399-6576.2001.045007911.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. Bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).
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Affiliation(s)
- Y Sow Nam
- Department of Anaesthesia and Intensive Care, Singapore General Hospital, Republic of Singapore
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Uejima T. General pediatric emergencies. Acute pulmonary edema. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:383-9, viii. [PMID: 11469070 DOI: 10.1016/s0889-8537(05)70234-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article focuses on three types of acute pulmonary edema in children: negative-pressure pulmonary edema, neurogenic pulmonary edema, and cardiogenic pulmonary edema.
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Affiliation(s)
- T Uejima
- Department of Anesthesia, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA
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