Postobstructive Pulmonary Edema Research Articles

Surviving the Unthinkable: A Case of Post-obstructive Pulmonary Edema and Cerebral Edema in a Suicidal Hanging Survivor

Surviving the Unthinkable: A Case of Post-obstructive Pulmonary Edema and Cerebral Edema in a Suicidal Hanging Survivor

Post Obstructive Acute Pulmonary Edema after Sedation

Post-obstructive acute pulmonary edema (POAPE) is a serious and rare respiratory complication, especially under sedation. We report the case of a patient without comorbidities undergoing sedated colonoscopy who developed respiratory distress, desaturation, and clinical and radiological signs suggestive of acute pulmonary edema. Etiological investigations, including cardiac assessment, returned normal, and the patient's condition improved within hours. The diagnosis of post-obstructive pulmonary edema was established. Through this case report, we emphasize the seriousness of this complication, necessitating early intervention.

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.

Copious white leathery tenacious froth in a case of hanging – An arcane presentation

Abstract The presence of froth during autopsy in cases of asphyxial death has been widely studied and attributed to drowning. Although hanging is the most common cause of mechanical asphyxia in comparison to drowning, frothing observed in cases of hanging has not been reported. Herein, we describe a case of an 18-year-old married pregnant woman who attempted suicide by hanging. During the postmortem examination, the presence of copious, white, tenacious, leathery froth forming a mushroom-like mass was observed. Furthermore, internal examination and histopathological evaluation revealed noncardiogenic pulmonary edema to be the likely cause of death. Although the development of postobstructive pulmonary edema has been effectively studied in sublethal cases of hanging, with appropriate ventilation management, mortality associated with such cases has drastically reduced. Thus, the incidence of frothing noted in such cases of hanging has not been described. Pulmonary edema, which subsequently develops in patients with hanging, is an unfamiliar and unusual cause of death. Hence, we conclude that autopsy surgeons must watch out for other causes of frothing and must investigate for evidence of its differentials, not limited to only cases of drowning. This finding also becomes important for emergency physicians to consider the development of interstitial edema in the setting of nonlethal hanging.

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.

Noncardiogenic pulmonary edema in small animals.

To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs. NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be dueto changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature,or a combination thereof.Possiblecausesinclude inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post-obstructive pulmonary edema), neurologic disease such as headtraumaor seizures (neurogenic pulmonary edema), electrocution,after re-expansion of a collapsed lung orafter drowning. Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left-sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis. The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases. Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE.

Prediction of Postoperative Pulmonary Complications in Patients Undergoing Functional Endoscopic Sinus Surgery: A Cohort Study

Introduction: Considering the pathophysiology of nasal obstruction, changes in certain parameters such as Peripheral Blood Eosinophil Count (PBEC), bedside pulmonary function test, Peak Expiratory Flow Rate (PEFR), and Electrocardiography (ECG) may have some correlation with postoperative pulmonary complications such as upper airway obstruction, loss of pharyngeal muscle tone, and postobstructive pulmonary oedema. Aim: To observe and analyse the changes in PBEC, bedside pulmonary function test, PEFR, and ECG in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Materials and Methods: A prospective cohort study was conducted at Bharati Hospital, Pune, Maharashtra, India over a two-year duration from December 2020 to October 2022. A total of 50 patients aged above 18 years undergoing FESS surgery were included in the study. The statistical analysis was performed using the Chi-square test and student’s t-test. After thorough preoperative evaluation, the aforementioned predictors were recorded. General anaesthesia management for FESS surgery was done according to the standard protocol. Vigilant intraoperative monitoring of vital parameters including peak airway pressure and plateau pressure was performed. After shifting the patients to the recovery room, they were observed for: 1) Hypoxia; 2) Hypercarbia; 3) Laryngospasm; 4) Bronchospasm; and 5) Pulmonary oedema. Results: A total of 50 patients aged between 18 years and 65 years with the mean age was 41.7±15.4 years were included in the study, with 32 males and 18 females. Only 24% of the study population showed postoperative hypoxia, while the rest of the complications were not observed in any patient. Changes in eosinophil count, PEFR, and ECG did not have any correlation with postoperative hypoxia and were statistically insignificant. Bedside pulmonary function tests, including the Sabrasez breath-holding test and the Sabrasez single breath count test, showed changes in 30% and 76% of patients, respectively. Forced Expiratory test change was seen in 72% of patients. Among these, 19.4% showed hypoxia. Out of the 12 cases showing postoperative hypoxia, seven had a disease duration of less than six months. Conclusion: The Sabrasez breath-holding test and Sabrasez single breath count are good predictors for postoperative hypoxia in patients undergoing FESS surgery. Shorter duration of nasal obstruction also showed postoperative hypoxia.

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.

Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children

The first-line treatment of obstructive sleep apnea syndrome in children is adenotonsillectomy, but this may result in perioperative respiratory adverse events (PRAEs). The primary aim of this study is to examine whether the McGill oximetry score (MOS) and other polysomnography parameters can predict major PRAEs following adenotonsillectomy. We secondarily evaluated the MOS interrater reliability and correlation with other polysomnography parameters. This retrospective study included all children aged 0-18 years who underwent preoperative polysomnography between June 2010 and January 2016 prior to adenotonsillectomy at a tertiary pediatric institution. Oximetries from polysomnograms were assigned an MOS. Univariable and multivariable models for prediction of major PRAEs were constructed. MOS was correlated with polysomnography parameters and interrater reliability was evaluated. This study included 106 children; 15 had a major PRAE. A multivariable prediction model that combined MOS and age showed evidence for the ability to predict major PRAEs with an area under the receiver operating characteristic curve of 0.68 (95% confidence interval: 0.52, 0.84), whereby increased MOS and younger age were associated with PRAEs, but apnea-hypopnea index was not. MOS had excellent interrater reliability (κ = 0.95) and was highly correlated with oxygen saturation nadir and cumulative time percentage with oxygen saturation less than 90%. A prediction model including MOS and age may predict PRAEs following adenotonsillectomy. This suggests that nocturnal oximetry provides the most essential information of polysomnography measures to direct postoperative monitoring following adenotonsillectomy. Xiao L, Barrowman N, Momoli F, etal. Polysomnography parameters as predictors of respiratory adverse events following adenotonsillectomy in children. J Clin Sleep Med. 2021;17(11):2215-2223.

Edema pulmonar postobstructivo (POPE) tras apendicectomía laparoscópica: a propósito de un caso

A case report of a young, athletic man admitted for acute appendicitis is presented. A few hours after laparoscopic appendectomy, the patient presented sudden dyspnea in the context of post-obstructive pulmonary edema, requiring urgent admission to the critical care unit. Due to the acute, unexpected and potentially fatal presentation of this pathology, we performed a review focused on it.

IT’S ALL IN THE STORY: A MISLEADING CHEST CT

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: An abnormal chest CT is a common reason for pulmonary consultation. There is a wide differential and a thorough history is important in helping to hone in on a diagnosis. Here, we present a case where the floridly abnormal chest CT was misleading. CASE PRESENTATION: The pulmonary team was consulted for an abnormal chest CT with request for bronchoscopy. A 32 yo woman without major past medical history presented to the ED short of breath - she described running for the bus and suddenly not being able to breathe. Labs on arrival significant for lactic and respiratory acidosis, suggesting near respiratory arrest. She improved rapidly with nebulizers, rest, and oxygen, and quickly weaned back to room air; her labs also improved rapidly. Her CXR showed patchy opacities so a chest CT was obtained showing diffuse ground glass opacities (Figure 1). She denied a wide range of exposures. Part of the thyroid obtained on the chest CT looked enlarged; she reported having been told several months ago that her thyroid was enlarged, and on exam it was noticeably large. A CT of the neck showed enlarged thyroid causing compression of the upper airway (Figure 2). We suspected the cause of her abnormal CT to be negative pressure pulmonary edema in the setting of likely upper airway obstruction caused by her enlarged thyroid. The initial ENT consult team did not feel this was related, however a secondary consult with endocrine surgery agreed with immediate resection of the thyroid. The patient was monitored in the MICU with heliox at the bedside, and underwent the resection without complication; she was surprisingly able to be intubated easily. She recovered fully and is now doing well; repeat CXR showed improvement. DISCUSSION: Negative pressure pulmonary edema (NPPE) is most commonly reported in the post-operative period from laryngospasm causing deep inspiration against a closed upper airway.1 This intense negative pressure pulls fluid into the alveolar space. Treatment involves addressing the underlying issue, whether it be laryngospasm or upper airway obstruction, with which the edema should rapidly resolve. Other cases have reported large thyroid masses causing similar presentations.2 Heliox can be used in cases of respiratory distress from narrowed airways, as its properties provide much less turbulent flow.3 It has been used to decrease intubation rates in children with croup, patients with subglottic stenosis, and even in severe asthma exacerbations. CONCLUSIONS: NPPE can cause an extremely abnormal chest CT, though the history and rapid improvement will help rule out other causes and rapidly narrow the differential. Heliox can be used to help improve oxygenation and ventilation in the setting of a narrowed upper airway. Patients improve with treatment of underlying obstruction or laryngopasm. Reference #1: Bhattacharya, M., Kallet, R. H., Ware, L. B. & Matthay, M. A. Negative-Pressure Pulmonary Edema. Chest 150, 927–933 (2016). Reference #2: Goh, K. J., Koh, M. S. & Tay, C. K. The Aftermath of Relieving an Upper Airway Obstruction. A Case of Postobstructive Pulmonary Edema. Am. J. Respir. Crit. Care Med. 198, e106–e108 (2018). Reference #3: Hashemian, S. M. & Fallahian, F. The use of heliox in critical care. Int. J. Crit. Illn. Inj. Sci. 4, 138–142 (2014). DISCLOSURES: No relevant relationships by Catherine Gao, source=Web Response No relevant relationships by Lisa Wolfe, source=Web Response

Incidence of immediate postextubation complications in critically Ill adult patients

BackgroundPostextubation complication rates vary among studies. It is necessary to standardize a method to identify postextubation complications and determine their potential association with extubation failure and reintubation in critically ill adult patients. ObjectivesTo describe immediate (up to 60 min) endotracheal postextubation complications in critically ill adult patients and determine whether these complications are associated with extubation failure. MethodsSecondary analysis of a Randomized Clinical Trial that included 240 critically ill adult patients, who were eligible for extubation. Overall complications include at least one major complication (upper airway obstruction, desaturation, vomiting, post-obstructive pulmonary edema) and/or minor complications (bronchospasm, severe cough, hypertension, tachycardia, tachypnea, poor respiratory mechanics). ResultsIncidence of overall, major and minor complications was 71.2%, 30.9% and 62.7%, respectively. Forty (16.9%) patients failed extubation, and thirty (12.7%) were reintubated. Of 168 patients who developed a postextubation complication, 137 (81.5%) were successfully extubated. Only major complications were significantly associated with reintubation after extubation failure (p<0.001). ConclusionWe have observed high incidence rates of overall, major and minor complications. The development of major complications was statistically significantly associated with extubation failure and reintubation. It is still unknown whether the identification and treatment of immediate postextubation complications have positive effects on patients' clinical course or whether the complications are a mere effect of the extubation procedure.

Polysomnography variables associated with postoperative respiratory issues in children

ObjectivesTo determine the polysomnogram (PSG) variables associated with increased incidence of postoperative respiratory complications in children <3 years of age undergoing adenotonsillectomy (T&A) for the management of obstructive sleep apnea (OSA). MethodsRetrospective case series of children <3 years of age who underwent T&A for the management of OSA at a tertiary care children's hospital from 1/1/08–6/1/2018. Postoperative hospital courses were analyzed to determine if certain clinical or PSG variables might have predicted an increased rate of respiratory complications. ResultsA total of 195 children <3 years of age with OSA on preoperative PSGs underwent T&A. The mean age of patients was 25.8 months (range 9–35 months). Seventeen patients (16.2%) had mild OSA, 35 (17.9%) had moderate, and 141 (72.3%) had severe OSA. Most patients (n = 155, 79.5%) required no respiratory intervention postoperatively. Those with severe OSA were more likely to require oxygen support (n = 25, 17.7%) when compared to those with mild-moderate OSA (n = 3, 5.6%). Patients admitted directly to the pediatric intensive care unit (PICU) from the sleep lab (n = 7) had a mean apnea-hypopnea index (AHI) of 63.6 events/hour (range 23–146/hr.), and a mean SpO2 nadir of 56.3% (range 46–68%). Four of these patients required CPAP after T&A. Of the 7 patients (3.6%) who required intubation after their procedure, only 1 did not have severe OSA, and 2 were intubated to manage post-obstructive pulmonary edema (POPE). Only 4 patients (4.2%) had unplanned PICU admissions. An AHI >12.7 events/hour, >18.5 obstructive apneas, and SpO2 nadir <72.5% were associated with a greater likelihood of requiring postoperative respiratory interventions. ConclusionsMost children <3 years of age, even with severe OSA, had no respiratory issues postoperatively. Those with severe OSA and hypoxemia admitted directly from the sleep lab were more likely to require CPAP postoperatively. All but one patient who developed POPE or who required intubation had severe OSA with associated hypoxemia on their preoperative PSGs.

Postobstructive pulmonary edema: A fatal complication in suicidal near-hanging

Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room.

PULMONARY EDEMA AND HEMOPTYSIS AFTER AN ORTHOPEDIC SURGERY

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Negative pressure pulmonary edema(NPPE) is an acute respiratory failure usually caused after a strong inspiratory effort generated against an obstructed upper airway[1]. CASE PRESENTATION: A 29-year-old man was admitted to the hospital for an elective open reduction with internal fixation of left bimalleolar ankle fracture. The surgery was uneventful. After extubation, he became hypoxic and started coughing up bloody phlegm without evidence of vomiting. He was afebrile, HR 96, RR 22 and BP 146/96. Chest x-ray showed bilateral alveolar consolidations in the upper and mid zones(Fig1). He was given Lasix 40 mg IV once and was transferred to the ICU. He was hemodynamically stable on high-flow oxygen. Arterial blood gas was showing pH of 7.41, PO2 98, pCO2 46 and HCO3 28.4. There was no evidence of swelling in the posterior pharynx. Lung exam showed good air entry on both sides, bilateral crepitations without wheezes. Laboratory work was unremarkable. Echocardiogram revealed normal ejection fraction, no significant valvular heart disease. He made a strong inspiratory effort after extubation due to upper airway laryngospasm and developed NPPE with alveolar hemorrhage. He was started on steroids. CT chest with contrast showed bilateral ground-glass opacities with alveolar infiltration in parenchymal hemorrhagic pattern(Fig2). He was continued on supportive treatment. Hemoptysis resolved in a day. He was transitioned to nasal cannula. Follow up chest x-ray showed significant improvement in alveolar infiltrates(Fig3). He was discharged home after a 48-h stay in the hospital. DISCUSSION: In adults, the most reported causes of airway obstruction leading to NPPE are in the context of laryngospasm following surgery[2]. The incidence of NPPE is as low as 0.1% of laryngospasm cases [3]. The first case of NPPE was reported and published in 1973 by Capitano and Kirkpatrick. There was a question whether NPPE was a result of high vessel permeability or hydrostatic pressure edema formation[1]. The high negative intrathoracic pressure generated to overcome the upper airway obstruction can reach -140 cm H2O[1]. The hydrostatic pressure in the pulmonary capillaries increases, the rate of interstitial fluid accumulation outgrows the capacity of the lymphatic drainage and fluid floods into the alveoli. Stress fracture can develop in the pulmonary capillaries leading to high permeability edema and blood-tinged secretions. Most cases of NPPE resolve in 24-48h. Diuretics have been used to hasten the resolution of the pulmonary edema. Beta agonist improves the clearance of the fluid by increasing active cation transport. In case of severe obstruction, cricothyroidotomy or tracheostomy can been used. Sedating and paralyzing the patient prevent more laryngospasm or biting of the endotracheal tube. CONCLUSIONS: NPPE is an entity not frequent encountered, but life threatening if not recognized or managed appropriately. Reference #1: M. Bhattacharya, R. H. Kallet, L. B. Ware, and M. A. Matthay, “Negative-Pressure Pulmonary Edema,” Chest, vol. 150, no. 4, pp. 927–933, Oct. 2016. Reference #2: A. Udeshi, S. M. Cantie, and E. Pierre, “Postobstructive pulmonary edema,” J. Crit. Care, vol. 25, no. 3, p. 538.e1-538.e5, 2010. Reference #3: B. Bhaskar and J. F. Fraser, “Negative pressure pulmonary edema revisited: Pathophysiology and review of management,” Saudi J. Anaesth., vol. 5, no. 3, pp. 308–313, 2011. DISCLOSURES: No relevant relationships by Arul Chandran, source=Web Response No relevant relationships by Michele Obeid, source=Web Response

NEGATIVE PRESSURE PULMONARY EDEMA FOLLOWING RELIEF OF UPPER AIRWAY OBSTRUCTION

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Obstructive sleep apnea (OSA) is associated with fragmented sleep caused by intermittent narrowing or occlusion of the upper airways leading to hypoxia. Uvulopalatopharyngoplasty (UPPP) is a common surgical treatment for adult patients with OSA. Complications are infrequent post-UPPP and include respiratory failure, hemorrhage, and hypertension. We report a serious complication of negative pressure pulmonary edema (NPPE) leading to respiratory failure after a UPPP procedure. CASE PRESENTATION: A 33 year-old-male with a past medical history of morbid obesity and OSA underwent UPPP without intraoperative complications. Immediately following extubation, he developed hypoxia refractory to increasing oxygen supplementation requiring intubation. The post intubation chest X-ray (CXR) showed diffuse pulmonary edema with a deep sulcus sign on the right. Extensive pink frothy secretions were suctioned repeatedly and required an endotracheal tube exchange. The repeat CXR showed worsening pulmonary edema and a right-sided pneumothorax which failed to improve despite right-sided chest tube placement. He subsequently required a second right-sided chest tube which expanded the right lung, decreased the peak pressures, and improved oxygenation. Echocardiogram was consistent with longstanding OSA and revealed a moderate to severely dilated right ventricle with reduced function. Patient’s condition improved rapidly with diuretics and aggressive mechanical ventilation; he was weaned off the ventilator and the chest tubes were quickly removed. After a short hospital course, he was discharged home in stable condition. DISCUSSION: The temporal cause of events following the relief of upper airway obstruction after UPPP suggests that NPPE was the cause of the respiratory failure. Clinicians need to be aware of this serious complication as rapid recognition can improve outcomes. NPPE can be classified as either Type I or Type II. Type I develops in patients who generate a negative intrathoracic pressure against acute airway obstruction. This can occur in patients with upper airway infections and laryngospasms leading to increased venous return and pulmonary edema. Type II develops after relief of chronic upper airway obstruction with loss of positive end-expiratory pressure (PEEP). The rapid removal of PEEP leads to interstitial fluid transudation and pulmonary edema. Regardless of type, patients usually present with hypoxia, pulmonary edema, and pink frothy sputum. Manifestations of acute airway obstruction may be present and include stridor with use of accessory muscles. Management is supportive with or without the use of diuretics. The use of positive airway pressure ventilation has been suggested for both acute management and prevention of pulmonary edema. CONCLUSIONS: Although a benign surgical procedure, UPPP has complications that need to be rapidly identified in the immediate post-operative period. Reference #1: Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011;5(3):308-13. Reference #2: Miro AM, Shivaram U, Finch PJ. Noncardiogenic pulmonary edema following laser therapy of a tracheal neoplasm. Chest. 1989;96:1430–1. Reference #3: Guffin TN, Harel G, Sanders A, Lucente FE, Nash M. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg. 1995;112:235–7. DISCLOSURES: No relevant relationships by Abdullah Al Twal, source=Web Response No relevant relationships by Kristin Fless, source=Web Response No relevant relationships by Sasa Ivanovic, source=Web Response No relevant relationships by Nirav Mistry, source=Web Response No relevant relationships by Vagram Ovnanian, source=Web Response No relevant relationships by Anish Patel, source=Web Response No relevant relationships by Fariborz Rezai, source=Web Response No relevant relationships by Paul Yodice, source=Web Response

Postobstructive negative pressure pulmonary oedema in a dog

A 4-month-old English bulldog was anaesthetised for investigation and management of chronic urinary incontinence. In the postanaesthetic period, the patient developed respiratory distress, with marked cough and increased inspiratory effort....

Autopsy Findings in a Patient with Post-Obstructive Pulmonary Edema

Post-obstructive pulmonary edema (POPE), a form of non-cardiogenic pulmonary edema, is a significant entity in anesthesiology and head/neck surgery. This rapidly developing and life-threatening condition occurs following the relief of the obstruction in the upper airways. This condition has two main categories with distinct etiology. We report the case of a 62-year-old Filipino female who developed POPE after the removal of the endotracheal tube following a routine biopsy of her maxillary mass. Immediately after the removal of the endotracheal tube, she presented with episodes of hypotension and desaturation. Chest x-ray post-re-intubation revealed bilateral lung opacities. The autopsy findings of the respiratory and cardiovascular system are presented.

Naughty onset of acute pulmonory edema in 11 year old adolescent boy

Post obstructive pulmonary edema (POPE) is a life-threatening complication occurring after relief of an upper airway obstruction. We report a case of 11-year-old boy developed POPE after accidental near hanging , who was recovered after supportive treatment and mechanical ventilation .POPE is reversible condition if recognized early and properly treated.

Acute Postobstructive Pulmonary Edema Following Laryngospasm in Elderly Patients: A Case Report

Only a few cases regarding postobstructive pulmonary edema following laryngospasm in older patients aged more than 60years have been reported; however, acute pulmonary edema or pulmonary hemorrhage would be more deadly to elderly patients who have cerebrovascular disease than young healthy adults. After review of the literature, we report an unusual case of a 67-year-old man with ischemic cerebrovascular disease, who underwent carotid angioplasty and stenting and experienced severe pulmonary edema and hemorrhage secondary to laryngospasm after general anesthesia with laryngeal mask airway. The patient required positive-pressure ventilation, supportive treatment, and active cerebroprotection in the intensive care setting for 3days before the edema resolved, and subsequently made a complete recovery without new onset of neurologic sequelae. The possible pathophysiological mechanisms, precaution, and preventative strategy of postobstructive pulmonary edema in older patients are discussed.