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Negative-pressure pulmonary edema (NPPE) is a rare complication that evolves rapidly after acute or chronic obstruction of the airways. The objective of this report was to present a case of NPPE after upper airways obstruction in a patient with acromegaly who underwent transsphenoidal hypophysectomy.
A 48 years old male patient, weighing 80 kg, phy...
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... Üst hava yolları obstrüksiyonu sonrası gerçekleşen ve pulmoner ödem bulguları olmayan olguların %29' unda PA akciğer grafisinin pulmoner ödemi ortaya çıkardığı gösterilmiştir [8]. Akciğer grafisinde diffuz bilateral alveolo-interstisiyel ödem, akciğer hilum genişliği gözlenirken, kalp büyüklüğü normaldir [9]. Bizim olgumuzda da akciğer grafisi ve tomografisi tanıyı netleştirmemizde bize faydalı olmuştur. ...
Negative pressure pulmonary edema (NPPE) is a rare complication that can occur after acute upper airway obstruction or secondary to relax chronic upper airway obstruction and a life-threatening fatal condition. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglottitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors. Supportive therapy is usually the only treatment. The fundamental principle of treatment is early diagnosis and to provide adequate oxygenation. Application of positive airway pressure is often provided with CPAP in most of patients, but sometimes re-intubation and mechanical ventilation may be required.
... Albergaria VF [8] presented a case of pulmonary edema after upper airways obstruction in a patient with acromegaly. Re-expansion pulmonary (RPE) develops upon rapid expansion of chronically collapsed lungs owing to increased pulmonary vascular permeability [9,10]. The risk factors include evacuation volume more than 2000 ml or lung collapse over a period of 3 or more days. ...
Patients with giant retroperitoneal liposarcomas are considered at great risks of perioperative complications and require meticulous anaesthetic management. There have been few reports about anaesthetic management of giant retroperitoneal liposarcoma. We present the case of a 66-year-old patient who suffered from a giant retroperitoneal liposarcoma (diameter 45 cm and weigh 4.5 kg), needing a resection surgery under general anesthesia. We successfully managed anesthesia procedures in this patient using FloTrac/VigileoTM monitoring system without major perioperative complications. The surgery was completed uneventfully and the patient recovered smoothly. After reviewing the literature, we summarize FloTrac/VigileoTM monitoring system is useful to help anaesthesiologists adjust infusion rate to maintain the stability of circulatory state. Anesthetic monitoring, fluid management and temperature control need to be focused in the anesthetic management.
... Cerebral hypoxia induced in animals has been shown to lead to pulmonary changes consistent with ARDS development [22] [23] [24]. During hanging attempts, acute negative intrathoracic pressure developing after upper airway obstruction may cause disruption of the alveolarcapillary membrane [25], which is termed negative pressure pulmonary edema [7] [8] [26] [27] or postobstructive pulmonary edema [6] [28]. Although the pathophysiology of negative pressure pulmonary edema involves hydrostatic pressure, this is not left atrial hydrostatic pressure, thus defining it as ARDS [25]. ...
Purpose:
The purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed.
Method:
The method is a single-center, statewide retrospective cohort study of consecutive patients admitted between August 2002 and September 2011, with a primary diagnosis of nonjudicial "hanging injury."
Results:
Of 56 patients, 73% were male. The median age was 31 (Interquartile range (IQR), 16-56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR, 3-15); 14% (8/56) had a GCS = 3. Acute respiratory distress syndrome developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS (3 [IQR, 3-7] vs 14 [IQR, 3-15]; P = .0003) and intubation in field or in trauma resuscitation unit (100% [5/5] vs 16% [8/51]; P = .0003) were associated with ARDS development. Risk factors of death were GCS = 3 (100% [3/3] vs 9% [5/53]; P = .002), pulselessness upon arrival of emergency medical services (100% [3/3] vs 4% [2/53]; P < .001], and abnormal neurologic imaging (50% [1/2] vs zero; P = .04).
Conclusions:
The ARDS case rate after near hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low.
... [11] Since then, only a few case reports / series of NPPE were published, and our understanding of the pathogenesis and treatment of NPPE remains limited. [12][13][14][15][16][17][18][19][20][21] Negative pressure pulmonary edema has been subdivided by Guffin et al. into two distinct classes. Type I, associated with forceful inspiratory effort in the context of an acute upper airway obstruction, and Type II, which occurs after the relief of chronic partial airway obstruction. ...
Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.
... NBAÖ, özellikle kas kitlesi yo¤un olan bu nedenle de yüksek inspiratuar negatif bas›nç oluflturma kapasitesi olan sa¤l›kl› gençlerde s›k gözlenebilir (6). Ayr›ca özellikle özel hava yolu ma-nipülasyonlar›n›n yap›ld›¤› servikal vertebra cerrahilerinde ya da transsfenoidal hipofizektomi gibi cerrahilerinin NBAÖ aç›s›ndan risk tafl›d›¤› bildirilmektedir (7). ...
... Akci¤er grafisinde diffuz bilateral alveolo-interstisiyel ödem, akci¤er hilum geniflli¤i gözlenirken, kalp büyük-lü¤ü normaldir (7). NBAÖ, ekstübasyondan hemen sonra ya da dakikalar içinde gözlendi¤i bildirilse de 60-90 dk sonra daha geç geliflti¤i de gözlenmifltir (9-10). ...
... NBAÖ, özellikle kas kitlesi yo¤un olan bu nedenle de yüksek inspiratuar negatif bas›nç oluflturma kapasitesi olan sa¤l›kl› gençlerde s›k gözlenebilir (6). Ayr›ca özellikle özel hava yolu ma-nipülasyonlar›n›n yap›ld›¤› servikal vertebra cerrahilerinde ya da transsfenoidal hipofizektomi gibi cerrahilerinin NBAÖ aç›s›ndan risk tafl›d›¤› bildirilmektedir (7). ...
... Akci¤er grafisinde diffuz bilateral alveolo-interstisiyel ödem, akci¤er hilum geniflli¤i gözlenirken, kalp büyük-lü¤ü normaldir (7). NBAÖ, ekstübasyondan hemen sonra ya da dakikalar içinde gözlendi¤i bildirilse de 60-90 dk sonra daha geç geliflti¤i de gözlenmifltir (9-10). ...
Negative pressure pulmonory edema (NPPE),followed by upper airway obstruction is one of the early postoperative complications. We present a case of NPPE that occured after general anesthesia for cervical discectomy.
Rationale:
Giant intra-abdominal liposarcomas weighing over 20 kg often increase the intra-abdominal pressure (IAP), which has severe effects on the cardiovascular and respiratory systems. Abdominal compartment syndrome is defined typically as the combination of a raised IAP of 20 mm Hg or higher and new onset of organ dysfunction or failure. The anesthetic management and perioperative management are very challenging.
Patients concerns:
We presented 2 patients with rare giant growing liposarcoma of the abdomen, weighing 21 kg and over 35 kg, respectively. Circulatory management was particularly difficult in the first case, while respiratory management and massive blood loss was very challenging in the second one.
Diagnosis:
With a computed tomography scan and peritoneal-to-abdominal height ratio measurement, preoperatively the risk of developing intra-abdominal hypertension and abdominal compartment syndrome was recognized early in each patient. The inferior vena cava and right atrium of the first patient was compressed and malformed due to the uplifted diaphragm, while there was severe decreased lung volume and increased airway resistance, because of rare giant retroperitoneal liposarcomas in the second case. Histologic examination revealed dedifferentiated liposarcoma in both cases.
Interventions:
Both of the patients underwent resection surgery with multiple monitoring; transesophageal echocardiography monitoring in the first case and pressure-controlled ventilation volume guaranteed mechanical ventilation mode in both cases.
Outcomes:
Intraoperatively and postoperatively no cardiopulmonary complications in both patients. The first patient was discharged without any complications on postoperative day 10, and the second patient underwent another surgery because of anastomotic leakage resulting from bowel resection.
Lessons:
Multiple monitorings, in particular transesophageal echocardiography should be considered in patients with increased IAP due to a giant mass, while an appropriate lung protection ventilation strategy is crucial in these patients.
Negative pressure pulmonary edema is an uncommon complication of the extubation of the endotracheal tube. An increase in intrathoracic pressure and negative pressure of the lung caused by acute laryngeal spasm results from acute upper respiratory obstruction causing life-threatening pulmonary edema by alveolar-capillary damage is called negative pressure pulmonary edema. We here describe 28-years old female case the preoperative diagnosis of pelvic inflammatory disease undergoing exploratory laporoscopy caused negative pressure pulmonary edema while extubation. With the immediate treatment, the patient was discharged without any abnormalities.
Rationale:
Negative pressure pulmonary edema (NPPE) is a dangerous clinical complication and potentially life-threatening emergency without prompt diagnosis and intervention during recovery period after anesthetic extubation.
Patient concerns:
A 25-year-old woman has undergone endoscopic thyroidectomy. After extubation, the patient developed acute respiratory distress with high airway resistance accompanied with wheezing, oxyhemoglobin saturation (SpO2) decreased to 70%. With positive pressure mask ventilation, her condition was stable, SpO2 99%. However, the patient developed pink frothy sputum with diffuse bilateral rales 30 min later after transported to surgical intensive care unit (SICU).
Diagnoses:
Negative pressure pulmonary edema.
Interventions:
The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and furosemide 20 mg was given intravenously.
Outcomes:
Postoperative day (POD) 2 her condition became stable, computed tomography (CT) scan indicated the pulmonary edema disappeared. The patient was discharged 6 days later. No abnormalities were observed during following 4 weeks.
Lessons:
Although usually the onset of NPPE is rapid, with individual differences NPPE is still challenging. Increased vigilance in monitoring, diagnosis, and treatment are essential to prevent aggravation and further complication.
