Edema e hemorragia pulmonar por pressão negativa associados à obstrução das vias aéreas superiores

Abstract

self-expanding metallic tracheal stent for the treatment of postintubation tracheal stenosis. Case reportA 25-year-old male professional athlete with postintubation tracheal stenosis underwent tracheal dilatation followed by the placement of a self-expanding metallic stent in the upper third of the trachea.Seven days after the implantation, the patient presented fever accompanied by subcutaneous emphysema in the cervical region. The leukocyte count was 25,000, with 8% rods. Computed tomography of the neck and chest IntroductionNegative-pressure pulmonary edema (NPPE), although uncommon, is a known entity related to upper airway obstruction. It is frequently underdiagnosed and potentially lethal. It occurs most frequently in patients with laryngospasm after procedures performed under general anesthesia.(1)The pathogenesis of NPPE is multifactorial, and the highly negative intrathoracic pressure associated with upper airway obstruction plays an important role. However, negative-pressure pulmonary hemorrhage has rarely been reported. (2,3) We report a case of negative-pressure pulmonary hemorrhage related to an obstructive upper airway process caused by a cervical and mediastinal abscess after the insertion of a Negative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.

Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures

“…A total of 69 studies, all of which were case series or case reports met final inclusion criteria (Supplemental Table 2). 2,3,9–73 Studies were dated between 1977 and 2016. In total, data from 87 individual patients was accessed across 69 studies.…”

Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities

“…[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. [12–21]…”

“…The pathogenesis of type 1 NPPE is multifactorial. [10–1221–28] The mechanism revolves around a large inspiratory force generated against an obstructed upper airway (modified Mueller maneuver) that leads to an acute and unusual elevation of negative intrathoracic pressure. Healthy human subjects can generate very high levels of negative inspiratory pressure with a reported maximum of – 140 cm H 2 O from a baseline of – 4 cm H 2 O.…”

“…[12152528] The extreme elevation in transmural pressure causes mechanical stress on the alveolar capillary membrane, leading to the transudation of erythrocytes into the alveoli, a process termed as ‘stress failure’. [28–30] Alveolar hemorrhage, the hallmark of capillary failure has been documented by bronchoscopy and bronchoalveolar lavage during the episodes of NPPE.…”

Negative pressure pulmonary edema in the prone position: a case report

“…Ultimately, intense inspiratory efforts while immersed in water may create a large negative intrathoracic pressure. The combination of these factors leads to stress failure of pulmonary capillaries and the breakdown of the alveolar wall, causing high-permeability’ pulmonary edema or even frank hemorrhage [12]. …”