Negative pressure pulmonary edema due to endotracheal tube bite in a patient who could not be placed guedel oropharyngeal airway before extubation.

Abstract

Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly after extubation in patients receiving general anesthesia. It may also occur due to the bite of the endotracheal tube prior extubation.Case presentation: A 52-year-old male patient was scheduled for ventriculoperitoneal shunt operation. General anesthesia was applied. Respiratory and hemodynamic variables were stable during surgery. At the end of the surgery, anesthetic drugs were discontinued, the lumen of the endotracheal tube and oropharynx were aspirated. When oropharyngeal airway was placed the patient bit and occluded his endotracheal tube, and began exerting breathing effort. Rapid desaturation was observed and pink foamy secretion came through the endotracheal tube. Bilateral diffuse crackles were present. A chest X-ray revealed bilateral pulmonary edema. The patient was transferred to the intensive care unit, sedation was applied and volume controlled positive pressure mechanical ventilation was started. The patient was extubated at the 12th postoperative hour and sent to the ward on the third postoperative day. Discussion: The extubation plan should be done well. Aspiration and extubation should be performed either under deep anesthesia or when the patient is fully awake. Oropharyngeal airway should be placed under adequate depth of anesthesia before extubation. Although oropharyngeal airway reduces the risk of biting of the endotracheal tube and subsequent development of negative pressure pulmonary edema, it may not prevent it completely. In negative pressure pulmonary edema treatment, invasive or non-invasive mechanical ventilation may be preferred depending on the severity of obstruction and degree of hypoxia. Early diagnosis and treatment of negative pressure pulmonary edema is life-saving.