Negative Pressure Pulmonary Edema Research Articles

Severe postoperative negative pressure pulmonary edema: a case report

BackgroundPostoperative negative pressure pulmonary edema (NPPE) can occur in any patient undergoing general anesthesia. There are several risk factors for it, especially postoperative laryngospasm. The disease is usually benign and quickly reversible. In our case the severity and need for advanced critical care therapy was unusual.CaseWe report a severe case of postoperative negative pressure pulmonary edema in a 62-year-old male patient undergoing elective right-sided retroperitoneoscopic adrenalectomy. The patient developed a severe case of acute respiratory distress syndrome (ARDS) after postoperative laryngospasm, possibly in conjunction with a suspected anaphylactic reaction. The patient was consequently treated with a combination of invasive airway pressure release ventilation (APRV) and a prone positioning regimen. After drastic improvement in respiratory function, the patient was discharged from the intensive care unit after 10 days and from the hospital after 14 days.ConclusionNPPE is a rare but relevant complication of anesthesia and laryngospasm. The disease can basically occur in any patient undergoing general anesthesia and therefore should be considered.

Een episode van niet-cardiogeen longoedeem bij een jonge, gezonde atleet

An episode of non-cardiogenic lung edema in a young, healthy athlete This article describes a case of a healthy, active 17-year-old man who underwent an elective endoscopic repair of an inguinal hernia under general anesthesia. After being extubated, he experienced a sudden episode of severe hypoxemic respiratory failure in the recovery room. Eventually, the diagnosis of negative pressure pulmonary edema (NPPE) or post-obstructive pulmonary edema (POPE) was made. This condition involves a non-cardiogenic pulmonary edema which occurs due to the generation of highly negative intrathoracic pressures. The most common cause in the adult population is post-extubation laryngospasm, where significant inspiratory forces are exerted against a closed glottis. Young athletes are at a heightened risk of experiencing this complication because they can develop intensely negative intrathoracic pressures. Given the limited treatment options available, it is crucial to prevent this phenomenon and to promptly identify it if present. Given its rarity and relative obscurity, the authors hope to raise the awareness for this phenomenon. It is a condition that any medical professional (internists, surgeons, anesthesiologists, intensivists) may encounter in his or her practice.

NEGATIVE PRESSURE PULMONARY EDEMA AFTER GENERAL ANESTHESIA

Abstract Negative pressure pulmonary oedema is a type of non-cardiogenic pulmonary oedema caused by strong inspiratory effort to overcome obstruction in the upper airways. The main mechanisms responsible for the pathophysiology are the increase in pulmonary capillary hydrostatic pressure and the increase in capillary membrane permeability that develops after the negative intrathoracic pressure increases with inspiratory effort. Although all causes that may lead to upper airway obstruction may play a role in the etiology, the most common factor is laryngospasm that develops during awakening from anaesthesia. Young male smokers under general anaesthesia are more at risk. Onset may vary from a few minutes to several hours after extubation or relief of laryngospasm. It leads to an acute respiratory failure that is potentially life-threatening and usually requires follow-up and treatment in the intensive care unit. The first step in treatment is to relieve airway obstruction and provide oxygen support. Positive pressure ventilation and use of diuretics are beneficial and usually tend to improve within 24-48 hours. The mortality rate is reported to be around 5% in case analysis reports of recent years. Since it is observed more frequently in anaesthetised patients, early diagnosis and treatment in the postoperative period is important. The aim of this review is to present a current perspective on negative pressure pulmonary oedema in the light of the literature.

Negative-Pressure Pulmonary Edema (NPPE)

Negative-Pressure Pulmonary Edema (NPPE)

Acute mediastinal mass syndrome after surgical biopsy of a massive anterior mediastinal tumor: a case report.

Mediastinal lymphatic tumors are relatively rare. The prognosis is poor but has improved due to recent advances in treatment strategies. Herein, we report a case of mediastinal lymphoma diagnosed using surgical biopsy, which was complicated by mediastinal mass syndrome due to general anesthesia. A 25-year-old man with cough, fever, dyspnea, and night sweats was transferred to our hospital for resection of a large anterior mediastinal tumor. Although his preoperative diagnosis was WHO type B1 thymoma, the clinical findings suggested a lymphoma. A repeat surgical biopsy was performed under general anesthesia. Immediately after extubation, the patient developed acute respiratory failure with hypolucency of the right lung field on chest radiography. He was reintubated immediately and was diagnosed with negative pressure pulmonary edema in the right lung. He was managed with positive-pressure ventilation and his respiratory distress resolved within 5 days. Pathological examination of surgical specimens confirmed the diagnosis of lymphoma. Surgical biopsy is useful for the diagnosis of mediastinal tumors. However, the risk of perioperative mediastinal mass syndrome should be carefully assessed before administering general anesthesia.

Postoperative Negative Pressure Pulmonary Edema

Postoperative Negative Pressure Pulmonary Edema

A case of negative pressure pulmonary edema caused by long-term burial of snow

A case of negative pressure pulmonary edema caused by long-term burial of snow

Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case.

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. 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. 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.

Negative pressure pulmonary edema (Review).

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.

Negative Pressure Pulmonary Edema due to Upper Airway Obstruction in Two Dogs

Two dogs were referred because of chronic cough and respiratory distress. One dog (Case 1) showed severe respiratory distress and mild interstitial patterns on the thoracic radiographs after external ring prostheses were placed to support a collapsing cervical trachea. The dog had received 1 mg/kg of furosemide three times daily for 2 days to treat pulmonary edema. Although appropriate treatment was provided to resolve pulmonary edema, persistent pulmonary edema and respiratory distress had been shown. There was no evidence of cardiogenic pulmonary edema based on the physical, radiographic, and echocardiographic examinations. The other dog (Case 2) was diagnosed with tracheal collapse and bronchomalacia. In addition, mild interstitial patterns were detected on the thoracic radiographs. There was no evidence of cardiac disease based on the physical and radiographic examinations. Because these findings were suspected to indicate negative pressure pulmonary edema due to airway obstruction, Case 1 was immediately given dexamethasone for 2 days to relieve postoperative swelling. Case 2 received 0.05 mg/kg of acepromazine for sedation and endotracheal intubation with positive-pressure ventilation for 2 days. All abnormal signs, including pulmonary edema, disappeared in Case 1, but Case 2 was discharged with a mild cough. This report describes the clinical course of negative pressure pulmonary edema due to airway obstruction in two dogs. Clinicians should be aware that airway obstruction can cause fulminant non-cardiogenic pulmonary edema in dogs.

Negative pressure pulmonary oedema and alveolar haemorrhage due to upper airway obstruction after parathyroidectomy

36-year old female underwent elective parathyroidectomy at a Swiss tertiary teaching hospital for primary hyperparathyroid-ism. Induction, surgery and extubation were uneventful. During transfer to the post-anaesthetic care unit, some retching was interpreted as vomiting. At arrival, she was apnoeic and unresponsive but with palpable pulse.

Negative Pressure Pulmonary Edema after Bilateral Nasal Packing following Transsphenoidal Pituitary Surgery for Nonfunctioning Pituitary Tumor

AbstractNegative pressure pulmonary edema (NPPE) is a well-known, albeit infrequent complication caused by upper airway obstruction. It may be seen after extubation following general anesthesia due to excessive negative intrathoracic pressure exerted against an obstructed upper airway. This leads to fluid extravasation from the pulmonary capillaries into the alveolar spaces and lung parenchyma. We report a case of NPPE after endoscopic transsphenoidal resection of the nonfunctional pituitary tumor, which occurred secondary to bilateral nasal packing. Reintubation and positive pressure ventilation were used to manage the patient, who was later extubated after the resolution of features of NPPE.

Negative pressure pulmonary edema after orotracheal extubation in emergency surgery

Negative pressure pulmonary edema after orotracheal extubation in emergency surgery

A rare case: negative-pressure pulmonary edema after routine rhinoplasty

Negative-pressure pulmonary edema (NPPE) is a very rare and dangeorus condition that generally occurs after general anesthesia in otorhinolaryngology practices. Post-obstructive pulmonary edema or NPPE caused by an acute pulmonary edema secondary to upper respiratory tract obstruction. Its sudden appearance in the early postoperative period can stress the surgeon and the anesthesiologist. Difficult breathing effort due to upper airway obstruction creates strong changes in intra-thoracic pressure, and high negative intrathoracic pressure increases the permeability of the alveolar capillary membrane, causing significant fluid changes in the pulmonary tissues. Treatment should be evaluated together with anesthesiologist or pulmonologist and the first goal should be to reduce the hypoxia.

Negative Pressure Pulmonary Edema (NPPE)

Negative pressure pulmonary edema (NPPE) is a rare but dangerous complication of general anesthesia that can lead to detrimental results, including anoxic brain injury or death, if not promptly recognized and treated. The purpose of this research is to educate professionals on the etiology, signs, symptoms, treatments, risk factors, and preventions to aid in the early recognition and treatment of NPPE. With a mortality rate up to 5%, proper provider education on NPPE is necessary to prevent its occurrence. This project followed a case report of an 18-year-old male who developed NPPE after a pilonidal cyst removal under general anesthesia.

A Case of Suspected Negative Pressure Pulmonary Edema after General Anesthesia.

Negative pressure pulmonary edema (NPPE) can occur rapidly after the release of an upper airway obstruction. In general anesthesia, NPPE can be caused by laryngospasm after extubation. This report describes a case in which NPPE was thought to have occurred after extubation during general anesthesia in a disabled person. The patient was a 28-yearold man, 160 cm in height and 56 kg in weight, who was scheduled for dental caries treatment under ambulatory general anesthesia due to intellectual disability. After induction of general anesthesia, nasal intubation was performed after sufficient oral suctioning to remove a large amount of serous secretion. After completion of dental treatment, pressurized extubation was performed after oral suctioning as sufficient spontaneous breathing and body movement were observed. Immediately after extubation, SpO2 dropped to 80%, subsequently recovering to 99% under oxygen administration at 5 liter/min with an oxygen mask. It dropped to approximately 85% again, however, when administration of oxygen was discontinued. Although communication with the patient was difficult, no expression of anguish or dyspnea was observed. A chest radiograph showed symmetric middle-lobe and lingular segment infiltrates, and the patient was transferred to the nearest general hospital. No obvious clinical findings other than a decrease in SpO2 were observed, suggesting NPPE as a result of airway narrowing due to secretions.

Negative pressure pulmonary oedema: Rare or overlooked entity?

Negative pressure pulmonary oedema: Rare or overlooked entity?

Atypical negative pressure pulmonary edema after extracorporeal membrane oxygenation therapy for COVID-19.

NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID-19 pneumonia 4 months ago. Capillary damage from COVID-19 might still exist.

Negative Pressure Pulmonary Oedema – Lessons learnt

A 56 year old female patient belonging to American Society of Anaesthesiologists Physical Status (ASA-PS) 1 underwent emergency laparoscopic appendectomy. Surgery was uneventful. After reversal of the neuromuscular blockade and extubation, patient sustained acute upper airway obstruction due to laryngospasm and developed negative pressure pulmonary oedema, which resolved after a period of about 15 hours of mechanical ventilation.

Negative-pressure pulmonary edema and alveolar hemorrhage are potentially life-threatening complications of upper airway obstruction

Negative pressure pulmonary edema and alveolar hemorrhage are potentially life-threatening complications after relief of upper airway obstruction. The laryngeal-pharyngeal obstruction results in high negative intrapleural pressures. The increased intrapleural pressures affect the integrity of the alveolo-capillary membrane due to various factors. This review describes clinical symptoms, etiologic factors, pathophysiology and treatment strategies associated with each of these factors. The aim of this review is to equip clinicians with the knowledge base necessary to identify patients at increased risk for negative pressure pulmonary edema and alveolar hemorrhage.