Case Scenario: Acute Postoperative Negative Pressure Pulmonary Edema

Negative Pressure Pulmonary Edema: A Rare Complication Following Extubation

“…The same statistics are shared by different authors [10,11]. It's more common in healthy and young males who are more pre disposed to major negative pressure differences [3,10]. In adults, 50% of cases are due to laryngospasm postoperatively, but can also occur by occlusion of the endotracheal tube by biting and less frequently after foreign body aspiration, oropharyngeal surgery or residual neuromuscular blockade [5].…”

“…Unilateral pulmonary edema is rarely found and has been associated with the positioning of the patient when the gravitational effects could interfere the presentation of the table [10,12]. In the absence of these differential diagnoses and evidence of acute obstruction of the upper airways is with the opportune diagnosis of NPPE [3,5].…”

“…The pressure gradient difference causes the fluid to move out of the pulmonary capillaries and flood the interstitial and alveolar spaces. There are four primary mechanisms: interstitial fluid in the capillary bed of the lungs or, (conversely, a decrease in pressure in the interstitium) decreased the plasma osmotic pressure, increased membrane permeability and decreased fluid to return through the lymphatic route [3,7].…”

“…Laryngospasm is defined as glottic occlusion, secondary to laryngeal constrictor muscles contraction (interarytenoids, lateral cricoarytenoids and internal and external thyroarytenoids), in response to a stimulus [3]. Laryngospasm and bronchospasm are manifestations of upper airways and lungs defensive reflex system.…”

“…The incidence of NPPE is 0.05 to 0.1% in healthy adults who underwent general anesthesia [2,3]. It is even less common with the use of a laryngeal mask airway [2].…”