Negative Pressure Pulmonary Edema Research Articles

Negative pressure pulmonary edema in a patient with COVID-19.

Negative pressure pulmonary edema (NPPE) should be considered in the differential diagnosis from an episode of asphyxia, and even if NPPE is diagnosed, the possibility of COVID-19 should be kept in mind under coronavirus pandemic conditions.

First report of a case of negative-pressure pulmonary edema during pregnancy

Abstract Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema (POPE) is a rare but life-threatening complication in the perioperative and critical care settings. In this study, we present the first case of NPPE in a pregnant woman. Case presentation A 39-year-old 31-week pregnant woman underwent transurethral lithotripsy. She had respiratory distress about 10 minutes after extubation. Chest imaging confirmed pulmonary edema. The patient was managed in the intensive care unit (ICU) with intravenous furosemide supplemental oxygen. Evaluations showed no heart failure, but laboratory tests confirmed the presence of primary hyperparathyroidism. She was discharged on 5th day without complication. Conclusion In this study, we reported the first case of NPPE in a pregnant woman. NPPE should be considered in differential diagnosis of respiratory distress during pregnancy.

Pulmonary edema in a pediatric cancer patient after anesthetic induction.

Negative pressure pulmonary edema (NPPE) in the context of anesthesia is a rare condition, although pediatric patients are at higher risk. This case stands out for the severe respiratory clinic that quickly developed in a child with a cancer history whose radiological and clinical presentation suggested multiple differential diagnoses, including tumor recurrence with metastasis or pulmonary tuberculosis. NPPE is a well-described, but a probably underrecognized clinical syndrome, that occurs after intense inspiratory effort against an obstructed airway. In clinical practice, when unexplained pulmonary edema takes place, NPPE should be considered in the differential diagnosis. NPPE usually has a favorable prognosis but pediatricians, radiologists, and anesthesiologists should be aware of this complication.

Point of Care Ultrasound-Diagnostic Approach of an Atypical Negative Pressure Pulmonary Oedema.

A 42 years old patient who underwent laparoscopic appendectomy developed negative pressure pulmonary oedema (NPPO) with an atypical presentation. Point of care ultrasound (POCUS) played a decisive role in the diagnostic approach. POCUS, as a goal-orientated tool, can provide key elements for a prompt diagnosis of respiratory and airway complications in the surgical patient. The identification of a B-line pattern, as an imagiological surrogate of alveolar oedema, with a specific distribution and the exclusion of other differential diagnosis using POCUS allowed for an early NPPO diagnosis. NPPO is a rare, potentially life threatening complication whose early diagnosis and direct treatment may lead to better outcomes. Our case emphasizes the diagnostic role of ultrasound in the operating theatre in the identification of life threatening airway and pulmonary complications, such as NPPO.

Unilateral Negative-Pressure Pulmonary Edema Following One-Lung Ventilation for Thoracic Surgery.

Unilateral Negative-Pressure Pulmonary Edema Following One-Lung Ventilation for Thoracic Surgery.

Negatieve-druklongoedeem: een zeldzame oorzaak van ernstige, maar reversibele respiratoire distress

Negative pressure pulmonary oedema: a rare cause for severe but reversible respiratory distress Negative pressure pulmonary oedema is a rare cause of reversible respiratory failure. It can occur after the development of a severe inspiratory force against an obstructed airway or, less often, after relief of a chronic airway obstruction. In the first case, this is most frequently seen in problematic endotracheal ventilation. Recognition and urgent treatment are primordial for a good outcome. The case described in this article concerns a young woman who underwent elective surgery complicated by a sudden onset of respiratory distress which led to the diagnosis of negative pressure pulmonary oedema.

Adverse events of sugammadex that occurred in a Korean population

BackgroundWith increasing use, the incidence of adverse events associated with sugammadex, a neuromuscular blockade reverser, is increasing. This study aimed to identify and analyze cases of adverse events caused by sugammadex reported in Korean population.MethodsOut of a total of 12 cases detected using various keywords in the Korean Journal of Anesthesia, Anesthesia and Pain Medicine (Seoul), KoreaMed, PubMed, EMBASE, Web of Science, and The Cochrane Library-CENTRAL from 2013 to December 2020, 10 cases directly associated with sugammadex were selected.ResultsAdverse events included five cases of anaphylaxis, one case of cardiac arrest, one case of profound bradycardia, one case of negative pressure pulmonary edema, and two cases of incomplete recovery. Three patients had American Society of Anesthesiologists physical status ≥ 3, two had emergency surgery, and two had a history of allergic reaction. Neuromuscular monitoring was applied in nine cases. The average dose of sugammadex was 2.87 mg/kg, and there were six cases in which one full vial was used, regardless of the state of neuromuscular recovery. Sugammadex was administered immediately after surgery in two cases, at train of four (TOF) 0 in four cases, at TOF 3 in one case, and after evaluation of the clinical signs only with no neuromuscular monitoring in one case.ConclusionsEven with neuromuscular monitoring, an excessive dose of sugammadex was observed. Given that adverse events tend to occur within 10 min of administration, continuous monitoring is important even after administration.

Negative Pressure Pulmonary Edema

Negative pressure pulmonary edema is a well-known clinical condition mostly affecting young healthy adults and at times pediatric patients. It occurs mostly acutely in patients who have experienced airway obstruction. Most common pathophysiology is the development of a negative intrathoracic pressure which results in increased preload and subsequently increase pulmonary hydrostatic pressures. The pulmonary edema develops once the airway obstruction is relieved and the forces opposing the transudation of fluid into the interstitial tissues are removed. Management includes a high index of suspicion in patients who have developed airway obstruction, early recognition, relief of obstruction, and maintenance of airway along with oxygen therapy. BIPAP or CPAP may be needed in patients who do not responds to these measures. Invasive mechanical ventilation with high FiO2 is reserved for refractory hypoxia.

Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy

Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy

A case of negative pressure pulmonary edema due to withdrawal syndrome in a tracheostomy patient

A case of negative pressure pulmonary edema due to withdrawal syndrome in a tracheostomy patient

Retrospective evaluation of negative‐pressure pulmonary edema in dogs (2006‐2018): 35 cases

To describe the clinical characteristics and outcomes in a population of dogs with negative-pressure pulmonary edema (NPPE) and to identify the main causes of the disease. To evaluate any associations with morbidity and mortality. Retrospective study. Three university teaching hospitals and 2 private referral centers in the United Kingdom. Thirty-five client-owned dogs presented with NPPE. None MEASUREMENTS AND MAIN RESULTS: Data collected included patient characteristics, clinical history, clinicopathological abnormalities, radiographic features, treatments, and outcomes. The median age was 4 months (range 2-90) and median weight was 7.1kg (range 1.7-37.2). There were many causes of NPPE including leash tugs, near hanging, accidental choking, anatomical obstruction to airflow, and purposeful airway obstruction by people. The most common cause of NPPE was accidental choking (40% of cases). Dogs with an anatomical obstruction were older than 24 months. Hypoxemia with an increased alveolar-arterial gradient was common on presentation. The majority of thoracic radiographs (65.7%) showed an alveolar or interstitial pattern in the caudodorsal area as previously described in the literature. Oxygen therapy was administered to 33 (94.3%) dogs. Furosemide was administered to 18 (51.4%) dogs. The median length of hospitalization was 2 days (range 0-14). Twenty-eight (80%) dogs survived to discharge. Seven dogs were mechanically ventilated and only 2 of them (28.6%) survived to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P<0.001). Most cases of NPPE occur in juvenile dogs. Different incidents associated with upper airway obstruction can produce an episode of NPPE. Choking on food or toys and near hanging have not been previously described in the veterinary literature as inciting causes of NPPE. The overall prognosis is good.

NONCARDIOGENIC NEGATIVE PRESSURE FLASH PULMONARY EDEMA IN A YOUNG ADULT PATIENT AFTER LARYNGOSPASM: A CASE REPORT

TOPIC: Respiratory Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Laryngospasm is a sudden involuntary muscular spasm of the vocal cords, it can lead to cardiac arrest due to hypoxia if not timely treated. Negative pressure flash pulmonary edema (NPPE) is a rare complication secondary to laryngospasm in adults after the acute treatment, which results from forceful inspiration against blocked airways and the resulting high negative pressure in alveoli, causing fluids to flux to the interstitial and alveolar spaces. Healthy individuals are more prone for NPPE due to the strength to induce higher intrathoracic negative pressure to challenge an obstruction. This case illustrates a young adult developed postoperative laryngospasm resulting in a flash NPPE. CASE PRESENTATION: A 40 year-old male, with a history of type 1 diabetes and recent mild COVID-19 Pneumonia was admitted for minor surgery. Pre-operative assessment concluded with ASA class 2, and moderate functional status. He has no history of anesthetic complications. Surgery was done under general anesthesia with a laryngeal mask (LMA). During Recovery after the LMA was removed, he started to desaturate, with audible stridor, cyanosis and retractions. High flow oxygen mask and IV Succinylcholine were given with no response. He was immediately intubated, ET tube suctioning showed large amounts of frothy pink secretions, his saturation had improved immediately to 100% with manual positive pressure ventilation. Sustained closure of the vocal cords was observed during intubation. However, his oxygen requirement didn't improve during the first day, and he failed a spontaneous breathing trial(SBT). Chest radiograph showed diffuse haziness suggestive of pulmonary edema. Chest CT showed pulmonary edema more significant in the dependent areas with atelectasis, it also showed diffuse ground glass opacities of recent COVID-19 pneumonia. He was started on parenteral furosemide, negative fluid balance of five liters was achieved in 24 hours. Surprisingly, his breathing effort was significantly improving with fluid elimination, oxygen requirements was weaned to minimum, passed SBT on CPAP mode, and later extubated. Patient was discharged with no evidence persistent airways pathology. DISCUSSION: Laryngospasm is less common in adults, usually it results from physical manipulation of the airways. Forceful inspiration against obstructed airways results in negative intrathoracic pressure above physiological limit, which disrupts the balance of hydrostatic pressures of alveoli, interstitium and the capillaries, leading to fluid accumulation in the alveolar space, it manifest clinically with desaturation, and diffuse opacities on imaging. High negative pressure increases the permeability as well, which drive the RBCs to extravasate and manifest as bloody mucous secretions. CONCLUSIONS: Fortunately, if NPPE gets timely recognized, patients respond magically to treatment with higher positive pressure ventilation and diuretics. REFERENCE #1: Bhattacharya M, Kallet RH, Ware LB, Matthay MA. Negative-Pressure Pulmonary Edema. Chest. 2016 Oct;150(4):927-933. doi: 10.1016/j.chest.2016.03.043. Epub 2016 Apr 8. PMID: 27063348. DISCLOSURES: No relevant relationships by Hasan Abuamsha, source=Web Response No relevant relationships by Hadeel Abuteer, source=Web Response No relevant relationships by Abdul Rahman Al Armashi, source=Web Response No relevant relationships by Isaac Alsallamin, source=Web Response No relevant relationships by Ameed Bawwab, source=Web Response No relevant relationships by Faris Hammad, source=Web Response No relevant relationships by Seshma Ramsawak, source=Web Response No relevant relationships by Francisco Somoza-Cano, source=Web Response

DIFFUSE ALVEOLAR DAMAGE COMPLICATING ELECTROCONVULSIVE THERAPY

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Electroconvulsive therapy (ECT) has been increasingly used over the last few years for various indications, of the rare complications described in the literature is pulmonary edema, only 9 case reports described this complication, 8 of which were attributed to none cardiogenic cause and one had a cardiology component. Here we present a case of pulmonary edema and diffuse alveolar damage (DAD) with hemorrhage with no cardiac component CASE PRESENTATION: 41 years old female smoker, known to have fibromyalgia, systemic lupus erythematosus (SLE) in remission for years, diabetes and severe bipolar disorder refractory to medical therapy' Patient were admitted to the hospital for ECT, shortly after the procedure she developed hemoptysis and shortness of breath requiring oxygen therapy, chest tomography ruled out pulmonary embolism but showed evidence of diffuse alveolar process with ground glass pacification (Image 2). no inhaled medications were used in anesthesia and other inhalational injuries ruled out by history, also vasculitis and infectious process were ruled out. bronchoscopy suggestive of DAD with hemorrhage (Image 1). review of the patient's anesthesia report showed no variation in vital signs during the procedure and ECHO was within normal. the patient recovered with supportive care and advised to be intubated on subsequent sessions DISCUSSION: None cardiogenic pulmonary edema has been described as a complication of ECT, while most cases describe it as a subsequence of variation in blood pressure during the procedure few described it as a result of pressure variation. The theory used to explain the development of pulmonary edema / diffuse alveolar damage is explained as the partially paralyzed diaphragm (Paralytic in smaller dose are used that doesn't result in complete paralysis of the diaphragm as the procedure is aimed to be short with minimal sedation) contract against a close epiglottis with abducted vocal cords from the ECT current. This will result in negative pressure inside the chest cavity and the development of shearing force resulting in damage of the small blood vessels and extravasation of blood and plasma into the alveolar space, which was the case in our patient. Other contributory causes were ruled out. recurrence is not common but precautions in subsequent sessions are warranted. the development of noncardiogenic edema is not a contraindication for further sessions. CONCLUSIONS: ECT is being widely used as a new modality for therapy for refractory psychiatric diseases, precautions to the possible complications are warranted, shortness of breath or hemoptysis post the procedure should raise the suspension of noncardiogenic pulmonary edema / diffuse alveolar damage. treatment is supportive with diuretics being the first line. no other therapies have been described. this complication warranted precautions in the following sessions but doesn't contraindicate them. REFERENCE #1: Manne JR, Kasirye Y, Epperla N, Garcia-Montilla RJ. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: a short review of the pathophysiology and diagnostic approach. Clin Med Res. 2012 Aug;10(3) 131-136. doi:10.3121/cmr.2011.1030. PMID: 22031475; PMCID: PMC3421372. REFERENCE #2: Hatta K, Kitajima A, Ito M, Usui C, Arai H. Pulmonary edema after electroconvulsive therapy in a patient treated for long-standing asthma with a beta2 stimulant. J ECT. 2007 Mar;23(1) 26-27. doi:10.1097/01.yct.0000263258.52162.63. PMID: 17435570. REFERENCE #3: Myers, Christopher & Gopalka, Ajay & Glick, David & Goldman, Morris & Dinwiddie, Stephen. (2008). A Case of Negative-Pressure Pulmonary Edema After Electroconvulsive Therapy. The journal of ECT. 23. 281-3. 10.1097/yct.0b013e3180de5d44. DISCLOSURES: No relevant relationships by Amro Alastal, source=Web Response No relevant relationships by Rami Batarseh, source=Web Response No relevant relationships by Christopher Lipinski, source=Web Response

Negative Pressure Pulmonary Edema After Electroconvulsive Therapy.

Negative Pressure Pulmonary Edema After Electroconvulsive Therapy.

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

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.

Kerosene Oil Pneumonitis

Radiographic abnormalities in the lungs are very common in an individual positive for HIV antibodies. Majority of lesions are of infective or neoplastic in origin. We present a case of chemical pneumonitis following regurgitation of kerosene oil in a patient positive for human immunodeficiency virus (HIV) antibodies. Chemical pneumonitis is diagnosed with a characteristic clinical history of regurgitation of fluid and gravity-dependent infiltration in the lung on chest x-ray. Another condition arising from the aspiration of the fluid/chemical is negative-pressure pulmonary oedema which results from laryngeal spasm following regurgitation of fluid. Chest radiography, however, distinguishes it from chemical pneumonitis. Bilateral infiltration is seen in the former, while lesion at dependent portion of right lung is seen in the latter condition.

Edema polmonare da pressione negativa dopo settoplastica in un adolescente

Negative pressure pulmonary edema (NPPE) is a danger-ous and potentially fatal condition with a multifactorial pathogenesis. NPPE is frequently a manifestation of upper airway obstruction, indeed the large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the main mechanism involved. The early detection of the signs of this syndrome is vital to the treatment and to patient outcome. The paper presents a case of NPPE due to post-extubation laryngospasm in a 14-year-old patient.

Negative Pressure Pulmonary Edema

Negative pressure pulmonary edema (NPPE) develops when a patient makes a forced inspiration against a closed upper airway resulting in transudation of pulmonary capillary fluid into the interstitium. Young, healthy athletic males are more susceptible to this complication, and NPPE is most frequently encountered during oral and maxillofacial surgeries. Patients who have undergone septorhinoplasty surgery have a significant risk for NPPE, unlike other cosmetic surgeries. Herein, we describe two cases of postoperative NPPE following a septorhinoplasty. Early symptoms of NPPE are severe respiratory distress, tachypnea, agitation, and crushed strawberry-colored bloody sputum during the early postextubation period. An early diagnosis of NPPE is very important, and patient recovery is quick when an early diagnosis is made.

Common Pediatric PACU Problems

Perioperative care of neonates, infants, and children significantly differs from that in adults. It was estimated that about 1.5 million to 2 million children under 3 years of age undergo anesthesia annually in the United States. Although the exact incidence of pediatric postoperative problems and complications are not quantified, it is known that both minor and major morbidity most commonly occurs in infants and children under 3 years of age, especially those with severe comorbidities. In the ever-growing field of pediatric same-day surgery, safe and efficient flow through the perioperative and postoperative periods necessitates in-depth knowledge of managing potential PACU complications. In this chapter, we provide an overview of specific and most common pediatric complications such as airway complications, postoperative nausea and vomiting, and emergence agitation. Although not novel, availability of an immediate response team (designated postoperative anesthesia staff) and availability of PACU standing orders avoids delays in physician evaluation, treatment, and length of pediatric patients’ distress. We also lay out criteria for discharge, as well as implementation of Postanesthesia Recovery Score system evaluations. This review contains 3 figures, 11 tables, and 52 references. Keywords aspiration, bronchospasm, discharge criteria, emergence agitation, emergence delirium, laryngospasm, negative pressure pulmonary edema, PONV, postintubation croup, vomiting

Veno-Venous Extracorporeal Membrane Oxygenation - Rapid Recovery for Post-Surgical Negative Pressure Pulmonary Edema

Introduction Postoperative pulmonary edema can be cardiogenic, non-cardiogenic or a combination of both. A major cause of noncardiogenic edema is negative pressure pulmonary edema (NPPE) due to inspiration against a closed glottis. Within minutes, patients can develop dyspnea and pink tinged frothy sputum. Risk factors include a short neck, obstructive sleep apnea, and previous ENT surgeries. There have also been a few case reports that demonstrate NPPE after the use of sevoflurane. Below we present a case of a young female who developed post-surgical NPPE which was managed with short-term veno-venous extracorporeal membrane oxygenation (V-V ECMO). Case Report A 30-year-old female with minimal past medical history was airlifted to the cardiovascular intensive care unit four hours after a condyloma removal under sevoflurane anesthesia with a laryngeal mask airway. The patient developed post-operative hypoxia and hemoptysis requiring intubation. A computerized tomography (CT) scan of the chest with contrast revealed ground-glass opacities concerning for diffuse alveolar hemorrhage (DAH). Upon arrival, a bronchoscopy with sequential lavages revealed persistently sanguineous fluid which pointed away from active alveolar hemorrhage. The ECMO team was consulted due to concerns for acute lung injury. Given the preserved cardiac function, the patient was placed on V-V ECMO for two days with rapid recovery of lung function. The patient was maintained on ventilator support for two additional days before being discharged on the fifth day. Summary The mainstay of treatment for NPPE is supportive care. Most patients require prolonged monitoring in the postanesthesia care unit and usually recover within a few hours with supplemental oxygen and continuous positive end-expiratory pressure. Occasionally, patients will need to be intubated. In this case, the post-procedural CT scan showed no signs of cardiogenic pulmonary edema, but rather DAH. Given ventilation difficulties with adequate cardiac function, the patient was an appropriate candidate for V-V ECMO. The DAH could possibly be due to sevoflurane but was more likely a consequence of NPPE. Regardless of the cause, the use of V-V ECMO is highly effective in allowing patients to rapidly recover respiratory function without long-term complications.