Acute postobstructive pulmonary edema

Abstract

Acute postobstructive pulmonary edema may occur after airway obstruction. A decrease in intrathoracic and intraalveolar pressures causes an increased blood flow into the pulmonary vasculature and favors the development of pulmonary edema. Two mechanisms for the development of acute postobstructive pulmonary edema are proposed: type 1 follows acute airway obstruction, and type 2 follows relief of chronic airway obstruction.

Acute Pulmonary Oedema Complicating Adenotonsillectomy for Obstructive Sleep Apnoea

“…This causes a rise in intrathoracic pressure, which compensates for the lower pressure on inspiration. With the relief of the chronic obstruction there is a sudden decrease in intrathoracic pressure, followed by increased venous return to the right ventricle, as well as increased pulmonary blood volume and hydrostatic pressure, all of which promote pulmonary oedema 5 . In our case, although there was mild desaturation, there was no gross acute upper airway obstruction before intubation, so our patient comes into the second group.…”

“…Although negative intrathoracic pressure is believed to be the principal cause in the development of pulmonary oedema in these cases, hypoxia and the hyperadrenergic state resulting from it also promote pulmonary oedema formation. This occurs as a result of the translocation of blood from the systemic to the pulmonary circulation, a generalised increase in pulmonary vascular resistance and increased pulmonary capillary permeability 3,5 …”

“…In children, the common obstructive events triggering obstructive pulmonary oedema are epiglottitis, croup, presence of a foreign body, and laryngospasm; the last is the commonest cause in adults 1 . Preoperative pulmonary oedema associated with adenotonsillar hypertrophy is well recognised 4 but, surprisingly, there have been few reports of acute pulmonary oedema complicating adenotonsillectomy 5,6 …”

“…Preoperative pulmonary oedema associated with adenotonsillar hypertrophy is well recognised' but, surprisingly, there have been few reports of acute pulmonary oedema complicating adenotonsillectomy. 5 •"…”

Negative‐pressure pulmonary edema in the otolaryngology patient

“…Negative‐pressure pulmonary edema (NPPE) has been defined in the literature as a noncardiogenic pathologic process in which a transudation of fluid into the pulmonary interstitium occurs in response to the generation of markedly negative intrathoracic pressures. NPPE is described as developing in two distinct clinical scenarios 1 . Type I NPPE occurs immediately after the onset of an acute upper airway obstructive process such as laryngospasm or epiglottitis.…”