Negative pressure pulmonary edema nppe is a medical emergency that usually arises from attempted ventilations against an acutely obstructed upper airway, such as occurs during laryngospasm. Pdf on jan 1, 2011, mukul c kapoor and others published negative pressure pulmonary oedema find, read and cite all the research you need on. Two days later, cxr showed improved pulmonary consolidation, and she was extubated picture 4. Negative pressure pulmonary edema has an incidence in the range of 0. Clinical features of patients with diffuse alveolar. Negative pressure pulmonary edema nppe is a dangerous and potentially fatal condition with a multifactorial pathogenesis. Pdf negative pressure pulmonary oedema researchgate. We aimed at describing the circumstances, clinical, radiological, and bronchoscopic features, as well as the outcome of patients with npperelated dah. Forceful inspiration against a closed epiglottis is. Negative pressure pulmonary edema nppe is potentially life threatening complication. Negative pressure pulmonary edema in children pathogenesis and clinical management ravi r. Negative pressure pulmonary edema nppe or postobstructive pulmonary edema is a well described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Negative pressure pulmonary edema nppe is a dangerous clinical complication and potentially lifethreatening emergency without prompt diagnosis and intervention during recovery period after anesthetic extubation.
Maxwell and mihm invite a further discussion of diuretic use in the setting of postoperative negativepressure pulmonary edema. Pulmonary edema is a potentially lifethreatening complication of acute airway obstruction. It is reported that the prevalence for nppe is less than 0. Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. Here, we report a case of relapsing polychondritis in an 18yold female who presented with recurrent nppe and acute. Relapsing polychondritis with initial presentations of. Apr 05, 2020 negative pressure pulmonary edema nppe occurs when a large, negative intrathoracic pressure is generated against an obstructed upper airway, causing fluid to shift into the lung interstitium. Dec 15, 2018 methylprednisolone 20 mg for 4 doses was administered. Nov 14, 2018 negative pressure pulmonary edema nppe is an infrequent complication of acute upper airway obstruction, with an overall prevalence of 0. Case report perianesthesia negative pressure pulmonary.
It has been noted as one of the complications of upper airway obstruction, which might be misdiagnosed1. Negative pressure pulmonary oedema kapoor mc indian j anaesth. The negative pressure causes hydrostatic edema that can be lifethreatening if not but minimized if treated early, usually resolves after 2448 hours. The pulmonary edema develops quickly in less than 10 min. It was first demonstrated in 1972 by rl moore in spontaneously breathing dogs exposed to resistive load. Lourdes al ghofaily, courtney simmons, linda chen and renyu liu department of anesthesiology and critical. Negative pressure pulmonary edema in which a significant negative pressure in the chest such as from an inhalation against an upper airway obstruction ruptures capillaries and floods the alveoli. It develops rapidly, without warning, in persons who are otherwise well.
This disorder is classified as type i or type ii1, 2, 3, 4. Negative pressure pulmonary edema after percutaneous. Prevalence of negativepressure pulmonary edema at an. Based on these disorders, upper airway obstruction is the trigger to induce negative pressure pulmonary edema. We read with great interest the reporting of a case with recurrent, acute negative pressure pulmonary edema. Negative pressure pulmonary edema was confirmed by chest xray, and shortlasting arterial desaturation despite positive pressure ventilation with high oxygen concentration. The patient was a 19 yearsold male with no chronic diseases or complaints in his preoperative assessment.
A 25yearold woman has undergone endoscopic thyroidectomy. Negative pressure pulmonary edema in children pathogenesis and clinical management. Thiagarajan mbbs mph cardiac intensive care unit, department of cardiology, childrens hospital. Negative pressure pulmonary edema after general anesthesia. Acute postoperative negativepressure pulmonary edema. Negative pressure pulmonary edema nppe is a form of noncardiogenic pulmonary edema pe that results from the generation of high negative intrathoracic pressure nip needed to overcome upper airway obstruction uao. Negative pressure pulmonary edema a lifethreatening. Pdf negative pressure pulmonary edema nppe is a dangerous and potentially fatal condition with a multifactorial pathogenesis.
Pulmonary edema diagnosis and treatment mayo clinic. From 1984 until 2001 several reports appeared in the literature519 discussing the phenomenon of acute, non cardiogenic pulmonary edema in response to acute or chronic upper airway obstruction. Negative pressure pulmonary edema nppe or postobstructive pulmonary edema is a well described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed. The clinical characteristics of negative pressure pulmonary edema renguang wu department of internal medicine, chungkang branch, cheng ching general hospital abstract negative pressure pulmonary edema nppe or postobstructive pulmonary edema popeis a form of noncardiogenic pulmonary edema that results from the generation of high negative. However except upper airway obstruction, there may be other pathophysiological disorders making patients more vulnerable to pulmonary. Exercise combined with negative pressure breathing induced the greatest changes in these cardiovascular indices and lung comet score. The aim of this report is to highlight the unusual presentation of negative pressure pulmonary edema. Relapsing polychondritis is a rare autoimmune disease causing inflammation in cartilaginous structures and other tissues throughout the body. This results in mechanical disruption of the alveolarcapillary mem. The acute form type i of negative pressure pulmonary edema. Review of lung, chest cavity thorax and throat anatomy, as. Postoperative pulmonary edema is a rare lifethreatening complication associated with general anesthesia. Negative pressure pulmonary edema nppe is a form of noncardiogenic pulmonary edema pe that results from the generation of high negative intrathoracic pressure nip needed to. Laryngospasms lead to forced inspiration, generating a large amount of negative intrathoracic pressure which leads to negative pressure pulmonary edema nppe.
Edema can be an adverse effect of certain medications. Negative pressure pulmonary edema nppe or postobstructive pulmonary edema is a welldescribed cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Negative pressure pulmonary edema nppe may develop in patients after inspiratory effort against an obstructed upper airway, 1 which causes very negative intrathoracic pressure, leading to leakage of fluid into the interstitium, 2 pulmonary edema and hypoxemia. The acute form type i of negative pressure pulmonary edema is discussed in this article as it presents following an acute obstruction of the upper airway. Nppe is a potentially lifethreatening complication that develops rapidly. The key roles of negative pressure breathing and exercise. Negative pressure pulmonary edema after acute upper airway obstruction. It is a known complication after nasal or upper airway surgery. Postobstructive pulmonary edema american family physician. Understanding negative pressure pulmonary edema springerlink. The large, negative pressures can be upwards of 100 cmh2o.
Case report open access negative pressure pulmonary edema in the prone position. Massachusetts general hospital, harvard medical school, boston, massachusetts, and universitat duisburgessen, germany. Negative pressure pulmonary edema npperelated diffuse alveolar hemorrhage dah is an underdiagnosed clinical entity seen with alveolar capillary damage. The high negative intrathoracic pressures cause increased venous return to the right side of the heart and increased hydrostatic pulmonary capillary pressure, and will favor the shift of fluid into the pulmonary interstitium causing pulmonary edema. Negative pressure pulmonary edema is a potentially lifethreatening. The afterloadincreasing effect of the muller maneuver increases this gradient because of elevated left ventricular, left atrial, and thus pulmonary capillary pressures. Negative pressure pulmonary edemarelated diffuse alveolar. Negative pressure pulmonary edemaa postanesthesia emergency.
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. Furthermore negative pulmonary pressure increases the mechanical stress on pulmonary capillaries. In negativepressure pulmonary edema right, negative interstitial pressure results in an increased hydrostatic gradient and alveolar flooding. The hypoxia changes pulmonary vascular resistance hypoxic pulmonary venous constriction, as opposed to elsewhere in the body. Frequently, nppe is a manifestation of upper airway obstruction, the. Negative pressure pulmonary edema is a potentially lifethreatening complication after general anesthesia in young healthy individuals that results from upper airway obstruction followed by strong inspiratory effort. Tests that may be done to diagnose pulmonary edema or to determine why you developed fluid in your lungs include. The negative pressure pulmonary edema is rare clinical situation which caused mainly by upper airway obstruction. Nppe is an example of a noncardiogenic pulmonary edema. Negative pressure pulmonary edema can be a lifethreatening postanesthesia complication. Characterizing postextubation negative pressure pulmonary. Negativepressure pulmonary edema chest journal american.
Pdf negative pressure pulmonary edema anaesthesia, pain. Negative pressure pulmonary edema after laryngospasm. Negative pressure pulmonary edema nppe is a potentially lethal medical emergency seen usually in the immediate postoperative period following extubation. Nppe is a relatively rare but potentially dangerous form of noncardiac pulmonary edema that results from vigorous patient inspiration against an obstructed upper airway. Case report negative pressure pulmonary edema in the prone. Postextubation negative pressure pulmonary edema nppe is an uncommon but important anesthesiarelated emergency presenting with acute respiratory distress and hypoxemia after removal of airway devices. Negative pressure pulmonary edema a lifethreatening condition in. An anesthetic management of negative pressure pulmonary edema. Occurrence of such a lifethreatening complication in an eye care setting where advanced intensive care is usually. This study investigated the incidence and associated risk factors for postextubation nppe during emergence. Negative pressure pulmonary edema nppe, the noncardiogenic pulmonary edema, is caused by upper airway obstruction and rapid negative intrapleural pressure increasing due to.
Frequently, nppe is a manifestation of upper airway obstruction, the large negative intrathoracic pressure. Negative pressure pulmonary edema is a potentially lifethreatening complication after general anesthesia in young healthy individuals that results from upper airway obstruction followed by. Before making the diagnosis of negative pressure pulmonary edema nppe, other causes of. Negative pressure pulmonary edema nppe is a rare complication that is more prevalent in young patients. Apr 28, 2017 diffuse alveolar hemorrhage dah with negative pressure pulmonary edema nppe is an uncommon yet lifethreatening condition. Nov 06, 2012 negative pressure pulmonary edema flash edema caused by sudden spasm of the larynx paroxysmal laryngospasm. Formation of noncardiogenic pulmonary edema has been observed after a variety of inciting events, including upper airway obstruction negative pressure pulmonary edema nppe,1 acute lung injury,2 anaphylaxis,3 fluid maldistribution,4 and severe central nervous system trauma neurogenic pulmonary edema. Negativepressure pulmonary edema nppe or postobstructive pulmonary edema is a well described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with severe postoperative noncardiogenic pulmonary edema who require mechanical. The negative pressure causes an increase in left ventricular preload and afterload. Negative pressure pulmonary edema nppe due to laryngeal swelling from relapsing polychondritis is rare and has not been reported. Maxwell and mihm invite a further discussion of diuretic use in the setting of postoperative negativepressure pulmonary edema nppe.
Negative pressure pulmonary edema nppe is an uncommon condition that occurs in the setting of upperairway obstruction at the time of emergence from general anesthesia in a spontaneously breathing patient. Negativepressure pulmonary edema nppe or postobstructive pulmonary edema is a well described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed. Negative pressure pulmonary edema nppe is a syndrome caused. The key roles of negative pressure breathing and exercise in. Negative pressure pulmonary edema postappendicectomy. Furthermore, this pressure causes a decrease in extramural hydrostatic pressure. Patients with nppe generate very negative airway pressures, which augment transvascular fluid filtration and precipitate. However except upper airway obstruction, there may be other pathophysiological disorders making patients more vulnerable to pulmonary edema. This case was a 5yearold girl with tumor on saddle area, her hormones level were abnormal preoperatively, such as cortisol. The aim of this report is to highlight the unusual presentation of negative pressure pulmonary edema nppe during and after.
A diver using negative pressure breathing while exercising is at greatest risk of developing interstitial pulmonary edema. It is potentially fatal if it goes unrecognized or is misdiagnosed. Negative pressure pulmonary oedema nppo represents a pure form of. Negative pressure pulmonary edema in children pathogenesis. Diffuse alveolar hemorrhage dah with negative pressure pulmonary edema nppe is an uncommon yet lifethreatening condition. The hypoxia changes pulmonary vascular resistance hypoxic pulmonary venous. Negative pressure pulmonary edema nppe is one of the common. Nppe usually results from acute upper airway obstruction, which is most commonly. However, this figure could be grossly underestimated due. Negative pressure pulmonary edema nppe is a rare postoperative complication that arises due to upper airway obstruction and appears within an hour of extubation. Negative pressure pulmonary edema is an extremely rare but potentially dangerous postoperative complication that occurs after relatively minor sports medicine and other orthopaedic. Negative pressure pulmonary edema in healthy cosmetic surgery.
Negative pressure pulmonary edema can rarely develop in patients with labored breathing in association with upper airway obstruction 1,2, subsequently inducing alveolar hemorrhaging. Negative pressure pulmonary edema nppe is an uncommon complication of anesthesia usually resulting from laryngospasm during extubation approximately 0. Acute postoperative negative pressure pulmonary edema. Furthermore negative pulmonary pressure increases the mechanical stress on pulmonary. Postextubation negative pressure pulmonary edema nppe is an uncommon but important anesthesiarelated emergency presenting with acute respiratory distress and hypoxemia.
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